loading…
loading…
loading…
Able-Bodied Adults Without Dependents (ABAWD) 111-7, 999-2
Advance Notice 777-5
Applicant 222-3
Applications 222-1, 222-6
Assets .. 333-1, 999-3
Assets Exclusions 333-2
Authorized Representative 222-3
Basis of Issuance 000-1
Boarders 111-1, 444-3
Budgeting 555-6
Budget Worksheet and Proration Chart 555-7
Categorically Eligible Households 444-8
Centers for the Treatment of Substance Use Disorders 444-5
Certification Periods 666-8
Certified Mail 777-7
Changes During the Certification Period 666-6
Child Support Deduction 555-5
Citizenship 111-2
Claims/Collection Procedures 777-3
Complaints 777-6
Confidentiality 1
Contract Income 444-2
Contradictory Information 222-5
Criminal Prosecution 777-2
Deductions 555-5, 999-3
Definitions 999-1
Dependent Care Deduction 555-5
Destitute Households 222-2
Disability 999-1
Discrimination 1
Disqualification Hearings 777-2
Disqualified Members 444-4
Disqualified Recipient Subsystem (DRS) 777-2
Documentation 222-5
Duplicate Participation 222-1
Earned Income 555-2
Earned Income Deduction 555-5
Earnings of Children 555-4
Electronic Benefit Transfer (EBT) 777-1
Employment and Training 111-5
SUBJECT SECTION
Excluded Income 555-4
Expedited Services 222-2
Fair Hearings 777-1
Farm Losses 444-2, 555-4
Filing an Application 222-1
Foster Care 999-1
Foster Care Payments 444-3
Gambling Winnings 444-12
Garnished Income 555-4
Good Cause 111-4, -5, 6
Grants, Loans and Scholarships 444-7; 555-1, -3, -4
Gross Income Test 000-1, 555-6, 999-3
Group Living Arrangements for Individuals with Disabilities 444-5
Head of Household 111-1
Homeless Shelter Deduction 555-5, 999-3
Household Concept 111-1
Identity 111-3, 222-4
Income and Assets of the Eligible Student 444-7
Income and Assets of the Ineligible Student 444-4; 444-7
Income and Eligibility Verification System (IEVS) 888-1, -2, -3, -4, -5
Income In-Kind 555-4
Income Producing Property 333-2; 555-2, -3
Ineligible Noncitizens 111-2, 444-4
Intentional Program Violation 444-4, 777-2
Interviews 222-4
Introduction 1
Job Quit 111-6
Jointly-Owned Assets 333-1, 444-8
Live-In Attendants 111-1, 555-5
Loans … 555-4
Lottery Winnings 444-12
Lump-Sum Income 333-1, 555-4
Mail Loss 777-4
Mandatory Verification 222-5
Mass Changes 666-7
Maximum Allowable Assets 333-1, 999-3
Medical Deduction 555-5
Migrant Farm Workers 444-2
Mixed Funded Households 444-11
Net Income Test 000-1, 555-6, 999-3
Noncitizens 111-2, 444-1, 444-4
Non-Compliance with Welfare Programs 444-10
SUBJECT SECTION
Non-Household Member 111-1
Notices 777-5
Overpayment 777-3
PaS Payments 555-1
Pass-through/GAP Payments 555-1
Processing Delays 222-6
Property 333-1, -2; 555-6; 666-6
Proration of Benefits 222-7; 555-6
Proration Chart 555-7
Prospective Budgeting 555-1
Prospective Eligibility 555-6, 666-6
Purchasing and Preparing Meals 111-1
Redetermination 666-9
Rental Income 444-2, 555-3
Replacement of Benefits 777-4
Reporting Requirements 666-6
Residence 111-3, 222-4
Residents of Centers for the Treatment of Substance Use Disorders or Group
Living Arrangements for Individuals with Disabilities 444-5
Restoration of Lost Benefits 666-10
Roomers 111-1, 444-2, 555-2
Self-Employment 444-2, 555-2
Shelter Deduction 555-5
Shelters for Battered Persons 444-6
Simplified Reporting 666-6
Social Security Numbers 111-4, 444-4
Sponsored Noncitizens 444-1
Standard Deduction 555-5, 999-3
Standard Utility Allowance 555-5, 999-3
Strikers . 444-9
Students 444-7
Supplements 666-6
TANF Payments 555-1
Thrifty Food Plan 000-1, 999-3
Time Limitations for Processing Application 222-6
Training Allowances 555-2
Transitional Food Assistance (TFA) 666-5
Transfer of Assets 333-4
Treatment of Income 555-1
Trust Funds 333-2, 555-3
Underpayment 666-10
Unearned Income 555-3
Vehicles 333-3
SUBJECT SECTION
Vendor Payments 555-4
Verification 222-5; 888-1, -2, -3, -4, -5
VISTA 555-4
Voluntary Job Quit 111-6
Voluntary Reduction in Work Effort 111-6
Work Requirements 111-5, 444-4
Zero Countable Gross Income 666-8
Alpha Index
Table of Contents
000-1 Basis of Issuance
1 Introduction
111-1 Household Concept
111-2 Citizenship Status and Noncitizen Status
111-3 Residence and Identity
111-4 Social Security Numbers
111-5 Work Requirements
111-6 Job Quit and Voluntary Reduction in Work Effort
111-7 Able-Bodied Adults Without Dependents (ABAWD)
111-8 Disqualification for Child Support Non-Compliance
222-1 Filing an Application
222-2 Expedited Service
222-3 Applicant/Authorized Representative
222-4 Interview Process
222-5 Verification and Documentation
222-6 Time Standards/Procedures
222-7 Approval/Denial Procedures
333-1 Maximum Allowable Assets
333-2 Asset Exclusions
333-3 Vehicles
333-4 Transfer of Assets
444-1 Sponsored Noncitizens
444-2 Self-employment, Migrant Farm Workers and Contract Employees
444-3 Boarders and Foster Care Payments
444-4 Disqualified Members
444-5 Residents of Centers for the Treatment of Substance Use Disorders or Group Living Arrangements for Individuals with Disabilities
444-6 Shelters for Battered Persons
444-7 Students
444-8 Categorically Eligible Households
444-9 Strikers
444-10 Non-Compliance with Federal, State, or Local Welfare Assistance Program Requirements
444-11 Mix-funded Households
444-12 Lottery and Gambling Winnings
555-1 Treatment of Income
555-2 Earned Income
555-3 Unearned Income
555-4 Excluded Income
555-5 Deductions
555-6 Calculating Eligibility and Monthly Benefit
555-7 Proration Chart
666-5 Transitional Food Assistance (TFA)
666-6 Changes During the Certification Period
666-7 Mass Changes
666-8 Certification Periods
666-9 Redetermination
666-10 Restoration of Lost Benefits
777-1 Fair Hearings
777-2 Intentional Program Violation (IPV)
777-3 Claims and Collections
777-4 Replacement of Benefits
777-5 Notices
777-6 Program Complaints
777-7 Electronic Benefit Transfer (EBT)
888-1 Type of Information Required and Source Agencies
888-2 Requesting Information about Applicants
888-3 Requesting Information about Recipients
888-4 Actions on Recipient Households
888-5 Use of IEVS Information
999-1 Definitions
999-2 List 1: Annual List of Geographic Areas Exempt from ABAWD Work Requirements
999-3 Charts
To determine a household's monthly benefit using the charts found in FS 999-3:
1) Calculate the household's net monthly income. Households which are not categorically eligible will have net monthly incomes which are lower than or equal to the amounts shown in Chart 1.
2) Multiply the net monthly income by 30 percent.
3) Round the product up to the next whole dollar if it ends in 1-99¢.
4) To obtain the household's allotment, subtract the result (steps 1-3 above) from the Maximum Benefit (Chart 5) for the appropriate household size.
5) Persons in household sizes one and two and which are categorically eligible will be eligible for benefits of at least those shown in Chart 6.
A. Supplemental Nutrition Assistance Program (SNAP) benefits are intended for the purchase of eligible foods, including seeds and plants. Persons outside the household may be designated to purchase food. Households are not required to have cooking facilities or access to cooking facilities to participate.
B. Certain households have been authorized by Congress to use FS to obtain prepared meals. Some examples of authorized providers are:
(1) Communal dining facilities for individuals who are elderly, with disabilities, are experiencing homelessness, etc.,
(2) Meals on Wheels for individuals who are elderly or house-bound,
(3) Centers for the treatment of substance use disorders,
(4) Group living arrangements for individuals with disabilities ("Individual with a disability" as defined in Section 999-1), and
(5) Shelters for individuals experiencing homelessness. (Section 999-1).
The Department shall use personnel employed in accordance with standards for a merit system prescribed by the U.S. Civil Service Commission for the determination of SNAP eligibility and benefit levels.
The Department shall retain all certification and fiscal records in an orderly fashion for a period of three years from the origin of the records.
A. The Department shall make rules and regulations available, upon request, to the general public.
B. Address Confidentiality Program
The Address Confidentiality Program, administered by the Secretary of State, provides address confidentiality for victims of domestic violence, stalking or sexual assault and requires state and local agencies and the courts to accept a designated address as the program participants' address when creating a public record. When an applicant or recipient verifies that they are a certified participant in the Address Confidentiality Program, the designated address is the only address
accepted and provided when staff is required to release information in each circumstance described.
C. The Department shall restrict the use or disclosure of information obtained from applicant and participating households to:
(1) Persons directly connected with:
(a) the administration or enforcement of the provisions of the Food and Nutrition Act of 2008 or regulations;
(b) other Federal assistance programs;
(c) federally-assisted State programs providing assistance on a means-tested basis to low income individuals;
(d) general assistance programs;
(e) the administration or enforcement of the programs which are required to participate in the income and eligibility verification system (IEVS) to the extent the SNAP information is useful in establishing or verifying eligibility or benefit amounts under those programs;
(f) the verification of noncitizen status of noncitizens applying for SNAP, through the Systematic Alien Verification for Entitlements (SAVE) Program including the Executive Office for Immigration Review (EOIR), to the extent the information is necessary to identify the individual for verification purposes;
(g) the administration of the Child Support Program; and
(h) the administration of federal work requirements and employment and training programs.
(2) and to
(a) employees of the Secretary of Health and Human Services as necessary to assist in establishing or verifying eligibility or benefits for Social Security or SSI;
(b) employees of the Comptroller General's Office of the United States for audit examination authorized by any other provision of law;
(c) the United States Department of Homeland Security if a Department staff member has seen a deportation notice for an applicant or household member;
and
(d) local, state, or federal law enforcement officials, upon their written request, if the officer furnishes the household member’s name and information that the household member is fleeing to avoid prosecution or custody for a felony, or is violating a condition of parole or probation; where the household member has information necessary for the apprehension or investigation of another member who is fleeing to avoid prosecution or custody for a felony, or has violated a condition of probation or parole. The Department
shall disclose only such information as is necessary to comply with a specific written request of a law enforcement official authorized by this section. This may include address, social security number and if available picture of the food assistance recipient in question, if requested.
NOTE: The written request shall include the identity of the individual requesting the information and his authority to do so, violation being investigated, and the identity of the person on whom the information is requested.
Recipients of this released information must adequately protect the information against unauthorized disclosure to persons or for purposes not specified in this section. In addition, information received through the IEVS must be protected from unauthorized disclosure as required by regulations established by the information provider.
Neither the Department nor its contractors shall discriminate against any applicant or participant for any reason whatsoever in any aspect of program administration. Enforcement action may be brought under any applicable Federal or State law.
The Department is an equal opportunity provider.
A. Americans with Disabilities Act
In accordance with the Americans with Disabilities Act, no qualified individual with a disability will, by reason of such disability, be excluded from participation in, or be denied the benefits of, the services, programs or activities of the Maine Department of Health and Human Services, or be subjected to discrimination by the Maine Department of Health and Human Services.
Individuals with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.
B. COMPLAINTS
The Department shall accept all complaints of discrimination, written or verbal, and forward them promptly to the Secretary or Administrator at the Department of Agriculture. People who believe that they have been subject to discrimination may also file a complaint directly with the Secretary of the Department of Agriculture. Title VI complaints shall be processed in accord with 7 C.F.R. Part 15.
To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) found online at: https://www.usda.gov/sites/default/files/documents/ad-3027.pdf, and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by:
(1) mailing it to:
Food and Nutrition Service, U.S. Department of Agriculture
1320 Braddock Place, Room 334
Alexandria, VA 22314;
(2) faxing it to: (833) 256-1665 or (202) 690-7442; or
(3) emailing it to: FNSCIVILRIGHTSCOMPLAINTS@usda.gov.
Benefits are issued electronically through the Electronic Benefit Transfer (EBT) System. (See Section 777-7). EBT cards are created and mailed by Maine’s EBT vendor or their designated subcontractor. Benefit authorizations are processed on a daily basis, Monday through Friday.
The regular monthly benefits are issued during a five-day period each month. Household benefits are available on the same date each month, (10th - 14th), once a household is included in the issuance cycle. The issuance date is based on the date of birth of the primary card holder.
A household must satisfy certain conditions, and the number of individuals in the household must be established, before financial eligibility can be determined. Factors affecting the composition of a household shall be verified, if it is contradictory to information known to or received by the Department.
A. Households must reside in the State of Maine.
B. Households must not live in an institution which provides the majority of meals, except for--
(1) federally subsidized housing for individuals who are elderly, built under either Section 202 or 236 of the National Housing Act et seq.
(2) centers for the treatment of Substance Use Disorders (Section 444-5).
(3) approved group living arrangements for individuals with disabilities (Section 444-5).
(4) shelters for battered persons (Section 444-6).
(5) shelters for individuals experiencing homelessness (Section 999-1).
NOTE: Individuals residing in correctional facilities are not eligible for SNAP during their stay, but may apply for benefits within 30 days prior to release. See Section 222-1.
A. an individual living alone;
B. an individual or a group of individuals who live with others, but purchase and prepare meals separately including roomers;
C. an individual at least 60 years of age who has a permanent disability which renders them unable to prepare their own meals and their spouse who live with others whose gross income does not exceed 165% of the Federal Poverty Level (Section 999-3 Chart 3);
NOTE: Exclude the individual who is elderly and their spouse when making this income determination.
or
D. a group of individuals who live together and purchase and prepare the majority of their meals together, even if the food is eaten elsewhere.
NOTE: Household members may be away from home part of the certification period but still be considered “living together”. The deciding factor to consider an individual part of a household is the “majority of meals” rule as stated above. Majority of meals can be determined by counting meals shared with the applicant household from the previous month or a longer past period not to exceed the previous certification period. The household and the Department will determine a representative period.
The following shall be considered as customarily purchasing food and preparing meals together even if they actually do purchase food and prepare meals separately:
(1) spouses residing together;
(2) parents and their natural, adoptive or stepchildren 21 years of age or younger with whom they are living;
NOTES:
(a) Ties to biological parents are severed permanently when a child is legally adopted by another person or for the duration of the guardianship designation when a child is placed under the guardianship of another person by the Court. If a child, their guardian and a biological parent reside together, only the child and guardian are mandatory members of the household.
(b) Ties to a stepparent are severed when a parent’s marriage to a stepparent is dissolved.
(c) In joint custody situations, where physical custody, including the purchase and preparation of meals is shared equally, the households may choose which household will receive SNAP benefits for the shared child(ren). The household applying for the shared child(ren) is assumed to be the household of choice unless the other household contacts the Office for Family Independence (OFI) with different information.
(3) children under 18 years of age (excluding foster children - see Section 444-3), living in a household in which another member is assuming parental responsibility; and
(4) boarders not paying an adequate amount for their meals. An adequate amount is determined by the Thrifty Food Plan (Section 999-3 Chart 5). When a boarder eats two meals or fewer per day the adequate amount is at least two-thirds of the Thrifty Food Plan.
A. boarders (Section 444-3) paying an adequate amount for their meals. The household can include such boarders as members of their household if they wish to do so.
B. roomers, if purchasing and preparing meals separately from the household.
C. live-in attendants.
D. disqualified members (Section 444-4).
E. other individuals who live with the household, but purchase and prepare their meals separately.
NOTE: These individuals are not considered when determining household size.
A. identify the total number of individuals who live together.
B. determine the relationship of individuals who live together.
C. identify members who--
(1) must be a member of the household;
(2) are members of the household by choice; or
(3) are not members of the household.
D. Include as household members those who must be household members and those who choose to be.
E. Once the household is established, identify members who are ineligible or disqualified (Section 444-4).
NOTE: These individuals' income and assets receive special treatment. They are not eligible for benefits (Section 444-4).
F. If separate household status is claimed, the claimant shall be responsible for proving that they are a separate household as defined in Section 999-1 and detailed in Paragraphs 2 and 3 above.
That responsible adult household member selected by all adult members of the household.
The household may designate their head of household each time the household is certified for participation in SNAP, but may not change the designation during the certification period unless there is a change in the composition of the household.
EXCEPTION: In situations where there are no children in the SNAP household, for purposes of failure to comply with work requirements, the head of household is the principal wage earner (that household member, including ineligible and disqualified members, who is the greatest source of earned income in the two months prior to the month in which the violation occurred).
Only U.S. citizens and certain noncitizens are eligible for SNAP benefits. The presence of an ineligible noncitizen or individual with unverified status does not prohibit the remaining members of a household from being certified.
Noncitizen status must be verified for each household member seeking SNAP benefits.
Citizenship status must be verified for any household member for whom it is questionable.
The following individuals are potentially eligible for Federal SNAP:
Individuals born in one of the 50 states, the District of Columbia, Puerto Rico, Guam, the U.S. Virgin Islands, the Northern Mariana Islands (NMI), American Samoa or Swain’s Island,
Individuals born to one or more U.S. citizens,
Individuals adopted by one or more U.S. citizens and residing in the United States prior to reaching the age of 18, and
Individuals who have been lawfully naturalized per 8 U.S.C. §§ 1421 and 1448.
Acceptable verification of U.S. citizen or U.S. national status is listed below. Verification from one list is only acceptable if no verification from any preceding list is available.
List A includes—
a data match showing U.S. citizenship or U.S. national status with a state or national database such as—
(i) the State Data Exchange (SDX),
(ii) the Beneficiary and Earnings Data Exchange (BENDEX),
the State Verification and Exchange System (SVES); or
(iv) the Systematic Alien Verification for Entitlements (SAVE) system.
(b) A U.S. public birth certificate showing birth in one of the 50 States, the District of Columbia, Puerto Rico (if born on or after January 13, 1941), Guam, the Virgin Islands of the U.S., American Samoa, Swain’s Island, or the Northern Mariana Islands (on or after November 4, 1986 (NMI local time)). The birth record document may be issued by the state, commonwealth, territory or local jurisdiction.
If the document shows the individual was born in Puerto Rico, Guam, the Virgin Islands of the U.S., or the Northern Mariana Islands before these areas became part of the U.S., see l through n of List B below.
(c) A U.S. passport:
Verification of U.S. citizen or U.S. national status include—
A U.S. passport, including U.S. passport card: a U.S. passport need not be currently valid to be accepted as evidence of U.S. citizenship as long as the passport was initially issued for the full validity period based on the persons age and for a period of five years or more, or
a currently valid U.S. passport or U.S. passport card regardless of limitation.
(d) A Report of Birth Abroad of a U.S. Citizen issued by the U.S. Department of State;
(e) A Certification of Report of Birth issued by the U.S. Department of State;
(f) A Certificate of Naturalization issued by the U.S. Department of Homeland Security (DHS) or its predecessors;
(g) A Certificate of U.S. Citizenship issued by DHS or its predecessors;
(h) A U.S. Citizen I.D. Card issued by DHS or its predecessors;
(i) A Northern Mariana Identification Card issued by DHS or its predecessors;
(j) An American Indian Card issued by DHS or its predecessors with the classification code “KIC” and a statement on the back denoting U.S. citizenship; or
(k) A statement provided by a U.S. consular official certifying that the individual is a U.S. citizen (given to an individual born outside the United States who derives citizenship through a parent but does not have an FS–240, FS–545, or DS–1350).
List B includes—
(a) A religious record recorded in one of the 50 states, the District of Columbia, Puerto Rico (on or after January 13, 1941), Guam, the U.S. Virgin Islands (on or after January 17, 1917), American Samoa, or the Northern Mariana Islands (on or after November 4, 1986, Northern Mariana Islands local time) (unless the applicant was born to foreign diplomats residing in such a jurisdiction) within three months after birth showing that the birth occurred in such jurisdiction and the date of birth or the individual’s age at the time the record was made. The record must be an official record recorded with the religious organization.
(b) A document showing employment by the U.S. government before June 1, 1976.
(c) Early school record showing a U.S. place of birth. The school record must show the name of the child, the date of the admission to the school, the date of birth, a U.S. place of birth, and the name(s) and place(s) of the birth of the applicant's parents.
(d) A federal or state census record showing U.S. citizenship or a U.S. place of birth and the individual’s age or date of birth;
(e) One of the following documents that show a U.S. place of birth:
(i) Seneca Indian tribal census record;
(ii) Bureau of Indian Affairs tribal census records or rolls;
(iii) U.S. State Vital Statistics official notification of birth registration;
(iv) A delayed U.S. public birth record that is recorded more than five years after the person's birth; or
(v) Statement signed by the physician or midwife who was in attendance at the time of birth.
(f) A final adoption decree showing the child's name and U.S. place of birth;
(g) In situations where an adoption is not finalized and the state in which the child was born will not release a birth certificate prior to final adoption, a statement from a state-approved adoption agency that shows the child's name and U.S. place of birth. The adoption agency must state in the certification that the source of the place of birth information is an original birth certificate;
(h) A U.S. Military Record showing a U.S. place of birth;
(i) An extract of a hospital record on hospital letterhead, indicating a U.S. place of birth. The hospital record must have been established at the time of the person’s birth and created at least five years before the initial application date for SNAP. A souvenir “birth certificate” issued by a hospital does not satisfy this requirement.
(j) A life, health, or other insurance record showing a U.S. place of birth. The record must have been created at least five years before the initial application date for SNAP.
(k) Medical (clinic, doctor, or hospital) record showing a U.S. place of birth created at least five years before the initial application date for SNAP. (For children under age 16, the document must have been created near the time of birth or five years before the date of application.) An immunization record alone is not considered a medical record for purposes of establishing U.S. citizenship.
(l) For individuals born in Puerto Rico prior to January 13, 1941—
(i) evidence of birth in Puerto Rico and the person’s statement that they were residing in the U.S., a U.S. possession, or Puerto Rico on January 13, 1941; or
(ii) evidence that the person was a Puerto Rican citizen and the person’s statement that they were residing in Puerto Rico on March 1, 1917 and that they did not take an oath of allegiance to Spain.
(m) For individuals born in the U.S. Virgin Islands prior to January 17, 1917—
(i) evidence of birth in the U.S. Virgin Islands, and the person’s statement of residence in the U.S., a U.S. possession or the U.S. Virgin Islands on February 25, 1927;
(ii) the person’s statement indicating residence in the U.S. Virgin Islands as a Danish citizen on January 17, 1917 and residence in the U.S., a U.S. possession, or the U.S. Virgin Islands on February 25, 1927, and that the person did not make a declaration to maintain Danish citizenship; or
(iii) evidence of birth in the U.S. Virgin Islands and the person’s statement indicating residence in the U.S., a U.S. possession, or Territory or the Canal Zone on June 28, 1932.
(n) For individuals born in Northern Mariana Islands (NMI) (formerly part of the Trust Territory of the Pacific Islands (TTPI)) prior to November 5, 1986:
(i) evidence of birth in the NMI, TTPI citizenship and residence in the NMI, the U.S., or a U.S. Territory or possession on November 3, 1986 (NMI local time) and the person’s statement that they did not owe allegiance to a foreign state on November 4, 1986 (NMI local time);
(ii) evidence of TTPI citizenship, continuous residence in the NMI since before November 3, 1981 (NMI local time), voter registration prior to January 1, 1975 and the person’s statement that they did not owe allegiance to a foreign state on November 4, 1986 (NMI local time); or
(iii) evidence of continuous domicile in the NMI since before January 1, 1974 and the applicant's statement that they did not owe allegiance to a foreign state on November 4, 1986 (NMI local time).
If an individual entered the NMI as a nonimmigrant and lived in the NMI since January 1, 1974, this does not constitute continuous domicile and the person is not a U.S. citizen.
(o) Evidence, from List A or items (a) through (n) of List B above, of the U.S. citizenship of the individual’s parents, evidence of the relationship of the individual to the parents, and evidence that at least one parent resided in the U.S. or an outlying possession prior to the individual’s birth.
(p) Evidence, from List A or items (a) through (n) of List B above, that one of the individual’s parents is a U.S. citizen and that the other is a U.S. noncitizen national, evidence of the relationship of the individual to the U.S. citizen parent, and evidence that the U.S. citizen parent resided in the U.S., a U.S. possession, American Samoa, or Swain’s Island for a period of at least one year prior to the applicant’s birth.
(q) Evidence, from List A or items (a) through (n) of List B above, of the U.S. citizenship of the individual’s mother, evidence of the relationship to the applicant, and—
(i) for births on or before December 24, 1952, evidence that the mother resided in the U.S. prior to the applicant’s birth; or
(ii) for births after December 24, 1952, evidence that the mother had resided, prior to the child’s birth, in the U.S. or a U.S. possession for a period of one year.
(r) A birth certificate showing birth in the Canal Zone on or after February 26, 1904 and before October 1, 1979 and evidence, from List A or items (a) through (n) of List B above, that one parent was a U.S. citizen at the time of the individual’s birth;
(s) A birth certificate showing birth in the Republic of Panama on or after February 26, 1904 and before October 1, 1979, evidence, from List A or items (a) through (n) of List B above, that at least one parent was a U.S. citizen, and evidence that the parent was employed by the U.S. government or the Panama Railroad Company or its successor in title.
(t) A marriage license showing marriage prior to September 22, 1922, and evidence, from List A or items (a) through (n) of List B above, that the spouse was a U.S. citizen.
(3) List C—
In the absence of any of the above verifications, all of the following must be provided.
A written affidavit of citizenship, signed under penalty of perjury, from a third party indicating a reasonable basis for personal knowledge that the member in question is a U.S. citizen or noncitizen national. The signed statement must acknowledge that the individual signing the affidavit recognizes that providing a false statement may result in penalties including disqualification from Public Assistance and Supplemental Nutrition Assistance Programs, and criminal penalties including a fine of $500 and 11 months of imprisonment.
Verification of the identity of the third party who signed the affidavit—
from List A above or
one of following documents, even if expired:
a driver’s license issued by a U.S. state or territory that includes either a photograph of the individual or other identifying information such as name, age, sex, race, height, weight, or eye color,
a school identification card that includes a photograph of the individual, or
c) a U.S. military card or draft record,
d) an identification card issued by the federal, state, or local government that includes a photograph of the individual or other identifying information such as name, age, sex, race, height, weight, or eye color,
e) a military dependent’s identification card,
f) a Native American tribal document,
g) a U.S. Coast Guard Merchant Mariner card.
h) a Certificate of Degree of Indian Blood, or another U.S. American Indian/Alaska Native Tribal document that includes a photograph or other personal identifying information relating to the individual.
In the absence of any of the documents described in subclause b-i or ii above, three or more corroborating documents such as marriage licenses, divorce decrees, high school and college diplomas from accredited institutions, including general education and high school equivalency diplomas, property deeds or titles, and employer ID cards can be used to verify the identity of an individual.
Verification of the citizenship or noncitizen national status of the third party who signed the affidavit from Lists A or B above; and
An affidavit signed by the individual, their guardian, or their authorized representative explaining why no verification from Lists A or B exists or can be obtained.
Verification
Acceptable Verification
In order to render a final eligibility determination, the Department needs to have received—
For status types that are not reflected in the Department of Homeland Security’s (DHS) data matching system, the “Acceptable Verifications” are detailed within that type below.
NOTE: this process applies to types that are never reflected in the DHS system, not instances that a particular individual’s status cannot be verified through the DHS system at a particular time.
For status types that are reflected in the DHS system, a data match with the Department of Homeland Security (DHS).
Supplemental Verification
(a) Supplemental Verification serves two purposes:
(i) These documents may aid the Department in securing required data matches.
(ii) In instances where a data match from DHS indicates that DHS cannot yet provide a definitive result due to a technical error, the Department shall honor the attested to status on the supplemental verification until such time that a data match response is received from DHS.
(b) Unless detailed otherwise within the type below, Supplemental Verification is the most current version of a letter or other document from DHS that includes—
(i) a statement that the individual has been granted the status,
(ii) the individual’s full name, and
at least one of the following:
the individual’s social security number,
the individual’s immigration related A-Number,
the individual’s passport number, or
the individual’s date of birth.
Controlling Verification Type
Once the Department receives a data match response from DHS, the data match from DHS is the controlling verification type. Should there be a discrepancy between this data match and the status attested to by the individual the Department shall—
use the status verified through the data match for all eligibility determinations and
provide the individual with contact information to resolve the conflict with DHS.
Individuals with the following noncitizen types are potentially eligible for Federal SNAP.
(1) Cuban and Haitian Entrants
(a) Description
(i) individuals granted and retaining Cuban and Haitian entrant status as defined in the notes of 8 U.S.C. § 1641;
(ii) any noncitizen who is a national of Cuba or Haiti and
was paroled into the United States and has not acquired any other status,
b) is the subject of removal proceedings or has an application for asylum pending; and
c) to whom a final order of removal has not been entered.
(iii) individuals who were granted Cuban and Haitian entrant status as defined in the notes of 8 U.S.C. § 1641 and did not have it terminated who now have a different status such as Lawful Permanent Resident.
(iv) individuals who, at one time, did or would have qualified per Subclause a (ii) above and retain a status that would otherwise qualify them for SNAP.
Special Conditions
Individuals who have been granted this status and have not had it terminated have no waiting period or other conditions to receive benefits, even if they currently hold a different status.
Additional Supplemental Verification for Cuban and Haitian Entrants
To aid in the verification process, individuals with this noncitizen status are encouraged to provide—
the most current version of a letter or other document from DHS stating that the individual has been granted Cuban and Haitian entrant status that contains the individual’s full name and at least one of the following:
the individual’s social security number,
the individual’s immigration related A-Number,
c) the individual’s passport number, or
d) the individual’s date of birth.
or
(ii) both—
a) a Cuban or Haitian Passport or Birth Certificate and
b) the most current version of a letter or other document from DHS stating that they have received an application for asylum for the individual that contains the individual’s full name and at least one of the following:
the individual’s social security number,
the individual’s immigration related A-Number,
the individual’s passport number, or
the individual’s date of birth.
(2) Effective March 9, 2024, certain citizens of the Federated States of Micronesia, the Republic of the Marshall Islands and the Republic of Palau.
Description
Individuals lawfully residing in the United States in accordance with the Compacts of Free Association (COFA) and 8 U.S.C. § 1641 as amended by the Consolidated Appropriations Act of 2024, P.L. 118-42.
(b) Special Conditions
Individuals who have been granted this status and have not had it terminated have no waiting period or other conditions to receive benefits, even if they currently hold a different status.
(3) Individuals who have been lawfully admitted for permanent residence
Description
Individuals meeting the definition of “lawfully admitted for permanent residence” as defined at 8 U.S.C. § 1101(a)(20) (“LPRs”).
Special Conditions
In addition to being an LPR, at least one of the following special circumstances must be met for individuals to be eligible for Federal SNAP:
(i) The individual was born on or before August 22, 1931 and was lawfully in the U.S. on August 22, 1996 as verified by a data match with DHS.
(ii) The individual has had a qualified status for a period of 5 years from the date of entry as verified by a data match with DHS.
(iii) The individual is under 18 years of age as verified by any government issued document.
(iv) The individual is receiving payments or assistance for blindness or disability.
Acceptable verification of this condition is—
(a) the individual receiving such payments or assistance from OFI;
(b) a data match with the Social Security Administration showing such payments or assistance; or
(c) documents from the agency providing such payments or assistance that contains the individual’s full name and either the individual’s date of birth or social security number.
(v) The individual is an honorably discharged veteran of or on active duty in the United States Armed Forces or is the spouse, unmarried widow, or unmarried dependent child of a veteran or active service member.
(a) A dependent child is the legally adopted or biological child of the individual. An individual ceases to be a dependent child:
1) the month following the month they reach the age of 18 if not a full-time student,
2) the month following the month they reach the age of 22 if they are a full-time student, or
3) never if they were determined disabled prior to their 18th birthday.
(b) Acceptable verification of this condition is:
1) Documents from the applicable branch of the Armed Services showing active-duty status other than training that contains the service member’s full name and either their date of birth or social security number; or
2) Documents from the Veterans Administration showing veteran status that contains the veteran’s full name and either their date of birth or social security number.
3) Verification that an individual meets this condition based on being the spouse or dependent child of the service member or veteran is—
a. documents from the applicable branch of the Armed Services or Veterans Administration showing eligibility for military or veterans benefits as a child or spouse that contains the individual’s full name and either their date of birth or social security number; or
b. the verifications detailed in (1) or (2) above, and
i. for a spouse, a marriage license naming the service member or veteran as the individual’s spouse; or
ii. for a dependent child a birth certificate or adoption record naming the service member or veteran as the individual’s parent and
A. if disabled, verification from the Social Security Administration,
B. if not disabled and between the ages of 18 and 22, school records naming the individual as a current student.
(vi) The individual has 40 qualifying quarters of work.
(a) This condition must be verified through a data match with the Social Security Administration (SSA).
(b) If the initial data match does not show 40 qualifying quarters, the individual states they have 40 qualifying quarters, and the individual is otherwise eligible, the Department shall issue Federal SNAP benefits for up to six months while the individual works with the SSA to rectify the count. If after six months a data match with the SSA still does not show 40 qualifying quarters, the household will be responsible for repaying the benefits issued in error.
NOTE: quarters attributed from a spouse cannot be counted if the individual divorced the spouse prior to the most recent certification for SNAP.
(vii) North American indigenous people born in Canada.
(a) Description
Individuals born in Canada who have at least 50% of their racial heritage from North American indigenous peoples.
(b) Acceptable Verification of this type is an American Indian Card issued by DHS or its predecessors with the classification code “KIC” and a statement on the back denoting U.S. citizenship.
(viii) Indigenous peoples eligible for special programs and services
(a) Description
A member of an Indian tribe as defined in section 4(e) of the Indian Self-Determination and Education Assistance Act (25 U.S.C. 5304) which is
recognized as eligible for the special programs and services provided by the U.S. to Indians because of their status as Indians.
(b) Acceptable Verification of this type is documentation from the Bureau of Indian Affairs conferring this status.
(ix) Individuals with certain prior humanitarian immigrations statuses
(a) Description
Individuals who are either
1) admitted to the United States as a refugee under section 207 of the Immigration and Nationality Act;
2) granted asylum under Section 208 of the Immigration and Nationality Act; or
3) whose deportation is being withheld under section 243(h) of the Immigration and Nationality Act.
4) individuals who were granted Special Immigrant Status for Certain Iraqis as defined in the notes of 8 U.S.C. § 1157 and did not have it terminated who are now LPRs
5) individuals who were granted Special Immigrant Status for Certain Afghans as defined in 8 U.S.C. § 1157 and did not have it terminated who are now LPRs.
6) Individuals granted Afghan humanitarian parole between July 31, 2021 and September 30, 2023 and did not have it terminated who are now LPRs.
7) Individuals granted humanitarian parole between February 24, 2022 and September 30, 2024 under Section 401 of the Additional Ukraine Supplemental Appropriations Act, 2022 whose parole has not been terminated and who are now LPRs.
(b) Additional Supplemental Verification for individuals with prior humanitarian statuses
In addition to verification from Department of Homeland Security (DHS) data matches, individuals may provide supplemental documentation to establish their status as a refugee, asylee, or with deportation withheld including:
1) immigration documentation including:
a. I-94 with refugee or asylee admission notation,
b. I-571 showing refugee status,
c. I-766 noting asylum or refugee category,
OR
2) official letters from DHS or United States Citizenship and Immigration Service (USCIS) such as:
a. Notice of grant of asylum or approval of refugee status,
b. Written verification from USCIS stating the individual’s status.
(x) Certain Hmong and Highland Laotians
(a) Description
1) individuals lawfully residing in the U.S. who were a tribal member of a Hmong or Highland Laotian tribe at the time the tribe assisted the U.S. military in a military or rescue operation between August 5, 1964 and May 7, 1975.
2) the spouse and/or unmarried dependent children of an individual described in (a) above, and
3) the unmarried, surviving spouse and dependent children of a deceased person described in (a) above except that the tribal member does not have to be lawfully residing in the U.S.
(b) Special Conditions
1) individuals who have this status based on being the spouse of a tribal member have that status terminated if they are divorced from the tribal member.
2) individuals who have this status based on being the surviving spouse of a tribal member have that status terminated if they marry a non-tribal member.
3) to have this status based on being the unmarried surviving dependent child of a tribal member, the individual must have fit the definition of a dependent child of the tribal member at the time of the tribal member’s death.
NOTE: for the purposes of this status, dependent child is the legally adopted or biological child of the individual.
4) individuals who have this status based on being the dependent child or surviving dependent child of a tribal member have that status terminated the earlier of the date—
a. they get married,
b. they exceed the maximum age to be considered a dependent child:
i. if they were determined disabled prior to their 18th birthday there is no maximum age.
ii. if they are not a full-time student, the maximum age is 17,
iii. if they are a full-time student , the maximum age is 21,
Or
c. if the tribal member is still alive, they no longer meet the definition of a dependent child (See (b)(3) NOTE, above) of the tribal member.
(c) Acceptable Verification of this type is—
1) for the tribal member
a. a data match with the United States Department of Homeland Security (DHS) showing—
i. a lawful presence;
ii. a date of birth prior to May 8, 1975;
iii. a country of birth of Laos, Thailand, Cambodia, China, Vietnam, The Philippines, Indonesia, Hong Kong, Malaysia, or Singapore; and
iv. a land date after March 1975.
If the land date is prior to April 1975, the standard is still met if the individual was in the U.S. as a student, for military training, to escape the war, or some similar purpose.
and
b. Either
i. their name is listed on the Refugee Data Center list, or
ii. if they cannot be found on the Refugee Data Center list an affidavit signed by the tribal member or, if they are deceased, their surviving spouse or child swearing under penalty of law that the individual was a member of a Hmong or Highland Laotian tribe between August 5, 1964 and May 7, 1975.
2) for the current or surviving spouse, or dependent child
a. verification of the eligibility of the tribal member as detailed in (1) above and
b. verification of the relationship to the tribal member such as a birth certificate, marriage licenses or tax records.
(xi) Amerasian Immigrants
(a) Description
(i) individuals granted and retaining lawful presence in the United States per the Amerasian Immigration conditions defined in the notes of 8 U.S.C. § 1101.
(ii) individuals who were granted lawful presence in the United States per the Amerasian Immigration conditions defined in the notes of 8 U.S.C. § 1101 and did not have it terminated who now have a different status such as Lawful Permanent Resident.
(b) Special Conditions
Individuals who have been granted this status and have not had it terminated have no waiting period or other conditions to receive benefits, even if they currently hold a different status.
(xii) Individuals who have been subject to severe forms of trafficking, their spouses, minor children, parents, and siblings
(a) Description
1) individuals meeting the definition of “victim of a severe form of trafficking in persons” as defined at 22 U.S.C. § 7105(b)(1)(C) or meeting all but the age requirement, and
2) the spouse, minor child, parent, or sibling of such an individual who holds a T Visa.
(b) Special Conditions
Individuals who have been granted this status and have not had it terminated have no waiting period or other conditions to receive benefits, even if they currently hold a different status.
(c) Acceptable Verification of this type is—
1) verification through the trafficking victims’ verification toll-free number, (866) 401-5510; or
2) a T Visa or other document from DHS stating that the individual has been admitted as a victim of severe forms of trafficking or a qualified relative of the same that contains the individual’s full name and at least one of the following:
the individual’s social security number,
the individual’s immigration related A-Number,
c. the individual’s passport number, or
d. the individual’s date of birth.
The Department provides an equivalent State funded food assistance program to households that would be eligible for Federal SNAP benefits but for their immigration status subject to the conditions described in this paragraph (“State Funded SNAP”). State Funded SNAP is only potentially available for individuals who are ineligible for Federal SNAP, if an individual is eligible for Federal SNAP that is the assistance they will receive.
A. Verification
Acceptable Verification
In order to render a final eligibility determination, the Department will need to have received—
(a) For status types that are not reflected in a data match with the United States Department of Homeland Security (DHS) the “Acceptable Verifications” are detailed within that type below.
NOTE: this process applies to types that are never reflected in the DHS system, not instances that a particular individual’s status cannot be verified through the DHS system at a particular time.
(b) For status types that are reflected in the DHS system, a data match with the Department of Homeland Security (DHS).
Supplemental Verification
Supplemental Verification serves two purposes:
These documents may aid the Department in securing required data matches.
In instances where a response from DHS indicates that DHS cannot yet provide a definitive result due to technical error, the Department shall honor the attested to status on the supplemental verification until such time that a data match response is received from DHS.
A data match or electronic verification through the Department of Justice (DOJ), Executive Office for Immigration Review (EOIR) is the preferred Supplemental Verification.
Controlling Verification Type
Once the Department acquires a definitive result from DHS, it is the controlling verification type. Should there be a discrepancy between this data match and the status attested to by the individual the Department shall—
use the status verified through the data match for all eligibility determinations and
provide the individual with contact information to resolve the conflict with DHS.
B. Grandfathered Individuals who meet the following conditions are potentially eligible for State Funded SNAP
(1) Description
Individuals who were receiving or had a pending application for federally funded Food Stamps, Food Supplement or SNAP benefits as of January 1, 2012.
(2) Special Conditions
(a) the individual must have been determined eligible back to January 1, 2012 and
(b) have had no subsequent lapse in eligibility.
(3) Acceptable Verification of this type is documentation in Maine’s eligibility system of uninterrupted eligibility since January 1, 2012 or a combination of documentation in Maine’s eligibility system and benefit award letters from other states or territories showing uninterrupted eligibility since January 1, 2012.
C. Individuals with the following noncitizen types are potentially eligible for State Funded SNAP provided they meet applicable Special Conditions for State Funded SNAP in Paragraph 4(D)
(1) Individuals who have been lawfully admitted for permanent residence as defined in 8 U.S.C. § 1101(a)(20) (“LPRs”) except that they do not meet the special circumstances, conditions, or other statuses for Federal SNAP listed in Paragraph 3.
NOTE: To be eligible for state funded benefits these individuals must, also, meet one or more of the conditions detailed in Subparagraph D(1), (2), or (5) below.
(2) Individuals who were members of groups eligible for Federal SNAP benefits prior to July 4, 2025.
(a) Certain individuals who have been battered and certain relatives of theirs
(i) Description
a) individuals granted and retaining immigrant status under the conditions of 8 U.S.C. § 1154(a)(1)(A)(iii), (iv), (v)(I)(cc), (vii), 1154(a)(1)(B)(ii), (iii), or (iv)(I)(cc).
b) individuals granted immigrant status under the conditions of 8 U.S.C. § 1154(a)(1)(A)(iii), (iv), (v)(I)(cc), (vii), or 1154(a)(1)(B)(ii), (iii), (iv)(I)(cc) who did not have it terminated and now have a different status such as Lawful Permanent Resident.
NOTE: Generally speaking, these are spouses and children of individuals lawfully in the U.S. who were battered while in the U.S. or are the parent or unmarried child of the battered individual. They must not be currently residing with the batterer.
(ii) Acceptable Verification of this type is—
a) a letter or other document from DHS, a court, or a law enforcement agency demonstrating a substantial likelihood that the individual, their parent, or their minor child was the victim of abuse by their spouse, or parent, or a family member there of that contains the individual’s full name and at least one of the following:
1) the individual’s social security number,
2) the individual’s immigration related A-Number,
3) the individual’s passport number, or
4) the individual’s date of birth.
and
b) a data match with the United States Department of Homeland Security (DHS) showing a lawful presence.
iii) Supplemental Verification
To aid in the verification process, individuals with this noncitizen status are encouraged to provide the most current version of a letter or other document from DHS stating that the individual has a lawful presence that contains the individual’s full name and at least one of the following:
a) the individual’s social security number,
b) the individual’s immigration related A-Number,
c) the individual’s passport number, or
d) the individual’s date of birth.
However, even with verification of lawful presences, this status is not verified without the verification of the abuse listed in ii(a).
(b) Certain individuals who have been paroled into the U.S. for one year or more for urgent humanitarian reasons or significant public benefit.
(i) Description
Individuals granted, for at least one year, and currently retaining immigrant status under the conditions of 8 U.S.C. § 1182(d)(5).
(c) Certain individuals who were granted conditional entrance prior to April 1, 1980.
(i) Description
Individuals granted conditional entrance per 8 U.S.C. § 1153(a)(7) as it was in effect May 31, 1980. The text of this law can be found at https://uscode.house.gov/statviewer.htm?volume=79&page=912#.
Individuals may also request copies by writing to:
Rules Manager
Maine DHHS, Office for Family Independence
11 State House Station
109 Capitol St.
Augusta, ME 04333-0011
(ii) Acceptable Verification of this type is a data match with the United States Department of Homeland Security (DHS) showing conditional entrance granted prior to April 1, 1980.
(d) The following individuals or groups are potentially eligible for State Funded SNAP prior to obtaining an adjusted status to LPR as described in Paragraph 3(B)(3) above.
(i) North American indigenous people born in Canada (See Paragraph 3(B)(3)(vii)).
(ii) Indigenous peoples eligible for special programs and services (See Paragraph 3(B)(3)(viii).
(iii) Individuals with certain prior humanitarian immigration statuses (See Paragraph 3(B)(3)(ix)).
(iv) Certain Hmong and Highland Laotians (See Paragraph 3(B)(3)(x).
(v) Certain Amerasians (See Paragraph 3(B)(3)(xi).
(vi) Certain victims of severe forms of trafficking (See Paragraph 3(B)(3)(xii)).
(3) Certain asylum seekers
(a) Description
Individuals who have filed an application for asylum and for withholding of removal with DHS or the DOJ immigration court.
(b) Supplemental Verification
To aid in the verification process, individuals with this noncitizen status are encouraged to provide the most current version of a letter or other document from DHS or DOJ stating that an application for asylum on behalf of the individual has been received that contains the individual’s full name and at least one of the following:
(i) the individual’s social security number,
(ii) the individual’s immigration related A-Number,
(iii) the individual’s passport number, or
(iv) the individual’s date of birth.
Certain individuals with temporary protected status
Description
Individuals who have been granted and retain temporary protected status per 8 U.S.C. § 1254(a).
Supplemental Verification
To aid in the verification process, individuals with this noncitizen status are encouraged to provide the most current version of a letter or other document from DHS stating that individual has been granted temporary protected status that contains the individual’s full name and at least one of the following:
(i) the individual’s social security number,
(ii) the individual’s immigration related A-Number,
(iii) the individual’s passport number, or
(iv) the individual’s date of birth.
D. Special Conditions for State Funded SNAP
In addition to the requirements of Subparagraph C, above, at least one of the following special circumstances must be met for individuals to be potentially eligible for State Funded SNAP:
(1) The individual is 65 years of age or older as evidenced by any government issued document
(2) The individual has a disabling condition
Description
The individual meets the definition of blind or disabled per 42 U.S.C. 1382c.
Acceptable verification of this condition is—
(i) the individual receiving disability related cash or medical assistance from OFI,
(ii) a data match with the Social Security Administration (SSA) showing the individual is receiving disability related cash or medical assistance from them,
(iii) a letter or other document from SSA showing the individual is eligible for disability related medical or cash assistance, or a favorable disability determination that contains the individual’s full name and either their date of birth or social security number; or
(iv) a current favorable disability determination from Maine’s Medical Review Team.
The individual cannot legally work
(a) Description
(i) the individual is subject to and within a waiting period before they can apply for an Employment Authorization Document (EAD), or
(ii) the individual is eligible for an EAD and has applied for it but has not received it.
(b) Acceptable verification of this condition is—
a data match with DHS showing that the individual is subject to and within a waiting period to apply for an EAD;
(ii) a data match with DHS showing that the individual has applied for Employment Authorization but has not yet received it; or
(iii) verification that the individual is an asylum seeker (See Subparagraph C(3)(b) of this paragraph), and that same verification shows that the application was received recently enough that the individual is still within the waiting period to apply for an EAD.
(iv) for a child under 18 verifications also includes either—
a birth certificate or adoption record naming the person verified as eligible through i, ii, or iii above as the individual’s parent or
b) a signed affidavit from the individual verified as eligible through i, ii, or iii above that the child is theirs.
(c) Supplemental Verification
To aid in the verification process, individuals with this special consideration are encouraged to provide the most current version of a letter or other document from DHS stating that they have received an application for an EAD from the individual. The document must contain the individual’s full name and at least one of the following:
(i) the individual’s social security number,
(ii) the individual’s immigration related A-Number,
(iii) the individual’s passport number, or
(iv) the individual’s date of birth.
(4) The individual or their parent was issued an EAD but is currently unemployed
(a) Description
(i) the individual was issued an EAD but has not found employment;
(ii) the individual was issued an EAD and lost all forms of employment; or
(iii) the individual is under 18 years of age and one or more of their parents in their household fits i or ii above.
(b) Acceptable verification of this condition is—
(i) verification of the end of any known employment consistent with Sections 222-5(2)(E), 555-2 p. 2, 666-6(2)(D)(3) and (3)(C)(2), and 666-9(5)(A)(1), and—
(ii) either
a) prior information in the OFI system that the individual received an EAD; or
b) a data match with DHS showing that the individual received an EAD.
(iii) for a child under 18 verifications also includes either—
a birth certificate or adoption record naming the person verified as eligible through i and ii above as the individual’s parent; or
b) a signed affidavit from the individual verified as eligible through i and ii above that the child is theirs.
(5) The Individual’s household is experiencing the effects of domestic violence
Description
One or more members of the household are experiencing domestic violence or the effects thereof by a spouse, a parent, or a member of the spouse’s or parent’s family residing in the same household as the applicant including—
(i) physical acts/threats of physical injury;
(ii) sexual abuse or assault of a child or caretaker of a child; or
(iii) psychological effects of abuse.
(b) Acceptable verification of this condition is a letter or other document that indicates the household member is experiencing domestic violence or the effect thereof from:
(i) DHS,
(ii) a court,
(iii) a law enforcement agency,
(iv) a governmental child or adult protective agency,
(v) a licensed social worker, or
(vi) a medical professional.
(c) The letter or other document must contain the household member’s full name and at least one of the following:
(i) their social security number,
(ii) their immigration related A-Number,
(iii) their passport number,
(iv) their date of birth, or
(v) in the case of verification from other offices within Maine’s Department of Health and Human Services or medical providers working with MaineCare, the household member’s identification number within OFI’s eligibility system.
(d) If documentation from (b) above cannot be obtained, a signed statement from:
(i) the individual,
(ii) the head of household, or
(iii) their authorized representative,
attesting to:
1. the Domestic Violence circumstances,
2. ongoing effects thereof, and
3. why no document from (b) above can be obtained.
b. Containing the household member’s full name and at least one of the following:
1. their social security number,
2. their immigration related A-Number,
3. their passport number, or
4. their date of birth.
NOTE: Supporting documentation may be required if articulable doubt exists regarding the credibility of the provided self-attested statements or forms.
General Rules
Citizenship, noncitizen status, and the special conditions described in this section must be verified at application or any time a change in these factors is reported by the household or a third party.
Per 8 U.S.C. § 1320b-7 the status of any noncitizen must, ultimately, be verified through a data match with DHS.
(3) The same processing standards (§§222-6, 222-7, 666-6, and 666-9), reasonable opportunity to provide verification (§§ 222-5, 666-6 and 666-9), and other considerations that apply to all other aspects of application or change reporting also apply to citizenship, noncitizen status, and the special conditions described in this section.
(4) Citizenship, noncitizen status and the special conditions described in this section only need to be verified for individuals attesting that such factors make them potentially eligible for SNAP benefits. Individuals who state their noncitizen status makes them ineligible for SNAP do not need to have their status verified. Other information, such as their income or assets may need to be verified.
(5) The presence of an ineligible member in the household does not preclude eligible members from receiving SNAP. Their income or assets may render the remaining members ineligible. (See Sections 444-1, 444-4, and 555-6.)
Processing
(1) Applicants are required to declare on behalf of each household member whether that member is a citizen or a qualifying noncitizen, or not.
(2) Applicants and participants are encouraged to provide the following at application or anytime they experience a change in citizenship, noncitizen status, or the special conditions described in this section:
(a) a declaration of their specific citizenship or noncitizen status and any special conditions described in this section,
(b) their full name and date of birth (citizens naturalized after their date of birth are encouraged to provide their date of naturalization as well), and
(c) at least one of the following enumerators:
For citizens and noncitizen nationals—
a social security number or
naturalization/citizenship number.
(ii) For noncitizens—
a) an immigration related A-Number,
b) an I-94 number,
c) a card/receipt number from a DHS document,
d) a passport number from a foreign passport and the name of the issuing country,
e) a U.S. Visa number, or
f) a Student and Exchange Visitor Information System (SEVIS) number; and
g) Any documentation that would serve as acceptable or supplemental verification of the declared citizenship, noncitizen status or special conditions as defined in Sections 3 and 4 above for the respective declaration of status or special conditions.
(3) At initial application or a reported change in citizenship, noncitizen status or special conditions the Department shall verify that the individual has provided the items detailed in 2 above.
If the individual states that they are a citizen or national of the United States, the following processes apply:
(i) If their status was previously verified with OFI, it is verified;
(ii) If they provide Acceptable Verification, their status is verified;
(iii) If they were not previously known to OFI and they do not provide Acceptable Verification the following processes apply:
If they do not provide their full name, the date they became a citizen or national, and a social security number:
1) their status is not verified and
2) the Department shall request this information and documentation in writing.
a. If they provide documentation, their status is verified.
b. If they provide their full name, the date they became a citizen or national, and a social security number or naturalization/citizenship number the steps outlined in Subclause a(iii)(b) below apply.
c. If they do not timely provide documentation or their full name, the date they became a citizen or national, and a social security number or naturalization/citizenship number, they are ineligible for failure to provide required documentation.
If they provide their full name, the date they became a citizen or national, and a social security number or naturalization/citizenship number—
their attested status is honored until determined to be questionable, as defined in Section 999-1.
the Department shall attempt a data match to verify their status.
If the data match is successful, their status is verified.
If the data match is not successful, the Department shall request documentation from the individual in writing.
If documentation is provided, the status is verified.
If documentation is not provided timely, the individual is ineligible for failure to provide the required documentation.
c. If they were previously known to OFI and had declared citizenship, but it had not been verified and they do not provide documentation, the Department shall request documentation from the individual in writing.
i. If documentation is provided, the status is verified.
ii. If documentation is not provided timely, the individual is ineligible for failure to provide required documentation.
(b) If the individual states that they are an eligible noncitizen other than a noncitizen national, the following processes apply:
(i) If the individual has not provided their name, date of birth, and at least one enumerator listed in Clause 2(c) above, the Department shall request them and any related Verification in writing.
a) If the individual provides at least their name, date of birth and an enumerator, the appropriate steps per Subclause b(ii) below apply.
b) If the individual does not provide at least their name, date of birth, and an enumerator timely, they are ineligible for failure to provide mandatory verifications.
(ii) If the individual provides their name, date of birth, and at least one enumerator listed in Clause 2(c) above, the Department shall attempt a data match to verify their status and special conditions.
a) If the data match supports the declaration(s) of status and special conditions they are verified until a change is reported.
b) If the data match with DHS does not support the declared noncitizen status or special conditions, the Department shall request documentary verification from the individual in writing (if it has not yet been provided or requested) and attempt subsequent data matches.
1) If at any point the data match supports declaration(s) of status and special conditions they are verified until a change is reported.
2) If the data match reflects the attested status and conditions but shows a subsequent change of status and/or conditions, the most recent status and conditions reflected in the data match are verified until a change is reported.
3) If the household refuses or fails to provide verification timely, the individual is ineligible for failure to provide required documentation.
4) If documentary verification has been provided, the Department shall attempt a data match in a period not to exceed 7 calendar days from the date the documentary verification is received by the Department. The attested status or special conditions are honored until such time that the data match provides the Department with a response based on the documentary verification provided by the applicant. If otherwise eligible, benefits will be granted until the data match response is received.
(iii) If the individual declares a status or special consideration that cannot be verified through a data match, the following processes apply:
a) If the Department has Acceptable Verification, the declarations are verified.
b) If the Department does not have Acceptable Verification, the Department shall request them from the individual in writing.
1) If Acceptable Verification is provided, the declaration is verified.
2) If Acceptable Verification is not provided timely, the individual is ineligible for failure to provide required verification.
NOTE: this process applies to types that are never reflected in the DHS system, not instances that a particular individual’s status cannot be verified through the DHS system at a particular time.
(iv) Special process for declarations that must or can be verified through means other than a data match or documentation (e.g. Individuals who have been subject to severe forms of trafficking)
a) The Department shall attempt to secure Acceptable Verifications via phone, fax, or other methods prescribed by the verifying agency.
b) If Acceptable Verification is provided, the declaration is verified.
If the agency verifies that the declaration is not applicable, the lack of status or special consideration is verified.
If additional information is needed to secure verification, the Department shall request it and any related documentation from the individual in writing.
If the necessary information is provided, the Department will attempt to secure the verification again.
2) If the necessary information is not provided timely, the individual is ineligible for failure to provide mandatory verification.
C. Mix-Funded Households
Some households include a mix of individuals eligible for Federal SNAP and individuals eligible for State Funded SNAP. In such cases, different funding sources may pay for benefits received by different parts of the household. See Section 444-11 for budgeting considerations.
D. Reporting Individuals with Deportation Orders.
If a Department staff member has seen a deportation notice for an applicant or household member, the Department shall report their name, address and other identifying information to DHS.
A household must be living in the State. Verification of identity and residence is required. Persons in the State solely for vacation, i.e., who intend to return to their home in another state within 30 days, shall not be considered residents. Residing in a permanent dwelling or having a mailing address is not required. Persons in correctional facilities must be in a state or county correctional facility within Maine, and intend to remain in Maine indefinitely upon release.
NOTE: When applying the “residence” rule, understand that the individual must be able to be considered a resident, for SNAP purposes, somewhere in the United States. If one or more other states refuse to consider the individual a resident of such state because the individual was or is present in Maine, consider the individual to be a resident of Maine.
EXCEPTIONS:
A. EXPEDITED SERVICE - Postpone verification of residence if it would delay processing.
B. INDIVIDUALS EXPERIENCING HOMELESSNESS - Do not require verification of residence.
When an applicant or recipient verifies that they are a certified participant in the Address Confidentiality Program, Department staff will accept the designated address as a program participant’s address when creating a SNAP record, unless Maine’s Secretary of State has determined that─
A. The Department has a bona fide statutory or administrative requirement for the use of the program participant’s address or mailing address, such that it is unable to fulfill its statutory duties and obligations without the residential address; and
B. The program participant’s address or mailing address will be used only for those statutory and administrative purposes. These purposes may include situations involving caseload distribution, work registration requirements, and Quality Control reviews.
A. Responsibilities of the Household--
(1) Verify Maine residence and identity with rent and mortgage receipts, utility bills, tax receipts, driver's license, etc.
(2) If no documents are available, provide the name and address of at least one collateral contact.
B. Responsibilities of the Department--
(1) Evaluate verification.
(2) Request additional information when verification is questionable.
(3) Document the case file.
GENERAL RULE - Each household member must furnish a Social Security Number or provide proof of application for one before certification. If a member has more than one Social Security Number, all numbers must be provided.
If the household is unable to provide proof of application for a Social Security number (SSN) for a newborn, the household must provide the SSN or proof of application at its next recertification or within 6 months following the month the baby is born, whichever is later. If the household is unable to provide a SSN or proof of application for SSN at its next recertification within 6 months following the baby's birth, good cause shall be determined.
Responsibility
FAILURE TO COMPLY: The household shall be advised that refusal or failure to provide a Social Security Number will result in disqualification of the non-complying member, unless good cause exists. See FS 444-4 for disqualification procedures.
GOOD CAUSE: Good cause exists if a "good faith" effort is being made by the household to fulfill its responsibility and cooperate with the Social Security Office and the agency. Individuals with good cause for failure to comply shall be allowed to participate for an additional month. A good cause determination must be made each month thereafter.
ENDING DISQUALIFICATION FOR FAILURE TO COMPLY: A disqualified individual may become eligible by providing a Social Security Number or proof of application.
VERIFICATION OF SOCIAL SECURITY NUMBER:
Social Security Numbers shall be verified through computer cross matching with SSA.
A. WORK REGISTRATION
Within 30 days of any application and once every twelve months after being found eligible, each household member age 16 through 59 who is not exempt pursuant to subsections 1 through 9, below, must register and maintain an active Maine JobLink account with the Maine Department of Labor and must comply with the provisions of the Responsibilities of Registrants section, below. Registration may be completed online, and may be prepared by someone acting on behalf of, and with consent of, the mandatory registrant.
B. EXEMPT MEMBERS
An individual is not required to participate in work registration, but may voluntarily participate when the household member is:
(1) age sixteen or seventeen and not the principal wage earner, regardless of student status.
(2) a student, regardless of age, who is enrolled at least half time in any recognized school, training program, or institution of higher education.
(3) working an average of thirty or more hours per week or, if working fewer hours, earning an average of the weekly equivalent of thirty hours at the federal hourly minimum wage.
(4) subject to, and complying with, a TANF work requirement.
(5) receiving or applying for unemployment benefits.
(6) caring for a dependent child under age 6.
NOTE: “Dependent Child” is a child who resides with a parent or stepparent or, in the absence of residing with a parent, a child who resides with an adult who is assuming parental responsibility for the child (see Section 111-1).
(7) caring for an incapacitated person who cannot provide their own care. The incapacitated person need not live with the SNAP household.
(8) physically or mentally unable to work thirty or more hours per week. When this is not apparent, or there is contradictory information, a doctor's statement or proof of disability benefits shall be required.
(9) a regular participant in a substance use disorder treatment and rehabilitation program.
C. RESPONSIBILITIES OF REGISTRANTS
Work registrants must:
(1) when required by these or applicable federal rules, participate in an employment/training program.
(2) comply with the work participation requirements of other means-tested public assistance programs, such as TANF/ASPIRE and General Assistance, if the participant is a member of the other program(s) in addition to SNAP.
(3) respond to requests from the Department, the Maine JobLink, and/or a prospective employer about employment status or availability for work.
(4) when referred by the Department or its designee, report for suitable employment.
(5) accept a bona fide offer of suitable employment.
A job is not suitable for purposes of this Clause or Clause 4, above, if:
(i) it pays less than the Maine minimum wage.
(ii) it is dangerous to health or safety.
(iii) daily commuting time of more than two hours is required, or the distance is unreasonable, considering the wage, commuting time and costs, or lack of transportation.
(iv) the registrant is physically or mentally unable to do the job.
(v) the registrant is required to join or quit a union.
(vi) there is a strike or lock-out at the work site.
(vii) it interferes with religious doctrine.
(viii) when the job is offered within thirty days of the initial registration, it is outside the registrant's major field of experience. A registrant is required to accept an otherwise suitable job when offered after the first thirty days.
D. DISQUALIFICATION PROVISIONS
(1) When a household member does not comply with a registration requirement and cannot show good cause, that member is disqualified from receiving SNAP.
(2) Start Date of Disqualification - The start date is the first of the month after normal procedures for closing or removal of the individual have taken place. Should a fair hearing delay the implementation, the period starts the first of the month following the decision upholding the agency.
(3) Disqualification Penalties and Ending Disqualification - Unless the member who was in violation becomes exempt for a reason other than TANF, PaS or UIB status, the disqualification period continues until the disqualified member both—
(i) complies with all registration requirements and
(ii) serves a penalty period of at least—
(a) one month for the first violation,
(b) three months for the second violation, or
(c) six months for the third violation and subsequent violations
which occurred 8/22/96 or later.
NOTE: If the person who caused the disqualification joins another household, the penalty follows them.
(4) SPECIAL RULES - TANF AND UIB - When a member who was exempt because of registration in TANF, PaS, or UIB fails to comply with a work participation requirement, the household is treated as though that member violated the SNAP work requirements.
EXCEPTION: A purely procedural requirement, such as submitting a monthly report form, shall not be considered a failure to meet work participation requirements.
E. GOOD CAUSE PROVISIONS
(1) When a work registrant fails to comply with the work registration, employment and training, or voluntary quit requirements, the Department may make a determination of Good Cause. The Department shall consider all facts and circumstances, including information submitted by the household member and the employer.
(2) Good Cause includes circumstances beyond the member's control, such as, but not limited to—
(i) illness,
(ii) illness of another household member requiring the presence of the member seeking Good Cause,
(iii) a household emergency,
(iv) the unavailability of transportation, or
(v) the lack of adequate child care for children between six and twelve years of age.
A. GENERAL RULE
Mandatory work registrants must accept referral to the appropriate SNAP Employment and Training Program (E&T) or SNAP E&T contracted agency.
B. RESPONSIBILITIES OF REGISTRANT - Those persons referred must comply with requirements set forth in the SNAP E&T Plan detailed in 10-144 C.M.R.Ch. 609, Supplemental Nutrition Assistance Program – Employment and Training (SNAP E&T) Program Rules. Persons with substantial barriers to participation may be excused from participation by SNAP E&T or the SNAP E&T contracted agency.
C. RESPONSIBILITIES OF SNAP E&T OR SNAP E&T CONTRACTED AGENCY—
(1) Each registrant who is referred shall be advised of the participation requirements, what constitutes noncompliance, and the consequences of noncompliance.
(2) When SNAP E&T or the SNAP E&T contracted agency determines that a mandatory registrant has failed, without cause, to comply, the OFI shall be notified. Appropriate disqualification action shall be started within ten working days after receiving the notice of noncompliance.
(3) In the event of a fair hearing, a SNAP E&T or the SNAP E&T contracted agency representative, as well as an OFI representative, shall represent the Department.
D. DISQUALIFICATION PROVISIONS - Same as for violation of any work requirement (see Paragraph 1(D) above).
E. GOOD CAUSE PROVISIONS - Same as for any work requirement (see Paragraph 1(E) above).
A. Disqualifying Action
When any of the following individuals has voluntarily and without good cause quit a job of 20 hours or more per week or that provided weekly earnings at least equivalent to the state or federal minimum wage (whichever is higher) multiplied by 20 hours or voluntarily and without good cause reduced their work effort (and, after the reduction, are working less than 30 hours a week), that individual is not qualified to receive SNAP:
(1) A household member not exempt from work registration (See Section 111-5);
(2) A household member who is only exempt from work registration (See Section 111-5) based on being subject to and complying with a TANF work requirement; or
(3) A household member who is only exempt from work registration (See Section 111-5) based on working an average of thirty or more hours per week or, if working fewer than 30 hours is earning an average of the weekly equivalent of thirty hours at the federal hourly minimum wage.
For applicant households, the job quit and voluntary reduction in work effort disqualification applies only if the violation occurred within 60 days prior to the application date.
B. Start Date of Disqualification
For applicant households, the start date is the day of the job quit or voluntary reduction in work effort. For households receiving SNAP benefits, the start date is the first of the month after normal procedures for closing or removal of the individual have taken place. Should a fair hearing delay the implementation, the period starts the first of the month following a decision upholding the Department’s decision.
C. Disqualification Penalties and Ending Disqualification
Unless the member who was in violation becomes exempt for a reason other than TANF or PaS or UIB status, the disqualification period continues until the disqualified member gets a new job with comparable salary or hours or, if disqualified for voluntary reduction in work effort, resumes working or gets a new job with at least 30 hours a week. The person is also disqualified for a period not less than one month for the first violation, three months for the second violation, and six months for the third violation which occurred 8/22/96 or later.
D. Good Cause
Good cause for leaving employment includes the good cause provisions found in Section 111-5 and resigning from a job that does not meet the suitability criteria specified in Section 1115. Good cause shall also include, but not be limited to:
(1) Discrimination by an employer based on age, race, sex, color, disabling condition, religious beliefs, national origin or political beliefs.
(2) Work demands or conditions that render continued employment unreasonable. An example would be not being paid on schedule.
(3) Acceptance of employment or enrollment of at least half time in a recognized school, training program, or institution of higher learning that requires the head of household to leave employment.
(4) Acceptance by any other household member of employment or enrollment in a recognized school, training program, or in another area which requires the household to move and thereby requires the head of household to leave employment.
(5) Resignations which are recognized by the employer as retirement.
(6) Employment which becomes unsuitable as specified in Section 111-5.
(7) Acceptance of a bona fide offer of employment of more than 20 hours a week (or the equivalent of 20 hours times the state or federal minimum wage, whichever is higher) and the job either doesn't materialize or ends up less than the 20 hours a week criteria.
(8) Leaving a job in connection with patterns of employment where workers frequently move from one employer to another. A couple of examples are migrant farm laborers and construction workers.
A government employee who is dismissed because of participating in a strike is considered to have quit without good cause.
A. The disqualification ends the day the disqualified member becomes exempt from work registration requirements for a reason other than being a TANF or unemployment compensation work registrant.
B. If the disqualified household member gets a new job with salary or hours greater than or equal to those of the job they quit or, if disqualified for voluntary reduction in work effort, resumes working at least 30 hours a week, that member’s disqualification ends the later of the date that they resumed work or—
(1) the date that is one month after the date the individual became ineligible, for the first work requirement violation;
(2) the date that is three months after the date the individual became ineligible, for the second work requirements violation; or
(3) the date that is six months after the date the individual became ineligible, for the third or subsequent work requirements violation.
An Able-Bodied Adult Without Dependents (ABAWD) is an individual who is—
at least 18 years of age, and
(2) in a SNAP household with no members under the age of 14, and.
(3) not exempt according to the conditions detailed in Paragraph 4, below.
An individual is no longer an ABAWD—
beginning the month they turn 65 years of age.
A. An ABAWD is not eligible for SNAP benefits if, during a “fixed” 36month period, the ABAWD received SNAP benefits for three countable months or more and was not at the same time:
(1) working in paid employment of at least 20 hours per week (averaged monthly); or
(2) participating in and complying with the requirements of a work program under the Workforce Investment Opportunity Act (WIOA) or a work program under the Trade Adjustment Assistance Act (TAA) for at least 20 hours per week (averaged monthly); or
(3) participating in and complying with the requirements of an employment training program operated by the State or political sub-division of the State, other than a job search program or a job search training program, for at least 20 hours per week (averaged monthly); or
(4) participating in and complying with the requirements of a workfare program or volunteer community service for a monthly maximum of the value of the household benefit divided by state or federal minimum wage, whichever is higher. The total number of monthly required hours may be met by the ABAWD individually or collectively by members of the SNAP household. Hourly requirements of a workfare program or volunteer community service are determined by dividing the SNAP household benefit allotment by the state or federal minimum wage, whichever is higher, rounded down to the nearest hour. Pursuant to Section 20(c) of the Food and Nutrition Act, no member will be required to work in any workfare or volunteer position to the extent that such work exceeds in value the allotment to which the household is otherwise entitled. In addition, no member may be required to work more than thirty hours per week when the required workfare or volunteer hours are combined with any other compensated work performed that week.
B. A fixed 36-month time period began October 1, 2023 and ends September 30, 2026. Subsequent time periods will follow using the same beginning and ending months, so the next fixed 36-month time period would start October 1, 2026 and end September 30, 2029.
C. A countable month (referred to in Sub-paragraph A above) is a month during which an individual receives SNAP benefits for the full benefit month while not an exempt member.
D. The work hours must be verified. In addition, ABAWDs must report when hours fall below 20 hours per week (averaged monthly), (except those working in a program described in Sub-paragraph A(4). above). If self-employed, the ABAWD must be employed for 20 hours or more per week and receive weekly earnings at least equal to state or federal minimum wage, whichever is higher, multiplied by 20 hours.
A. If an individual would have worked an average of 20 hours per week but missed some work for Good Cause, the individual is considered to have met the work requirement if the absence from work is temporary and the individual retains their job.
B. Good Cause includes circumstances beyond the individual's control, such as, but not limited to—
(1) illness,
(2) illness of another household member requiring the presence of the member,
(3) a household emergency, or
(4) the unavailability of transportation.
The individual is exempt from the work requirements in Paragraph 2 above if the individual is one or more of the following:
A. Exempt from work requirements listed in Section 111-5(1)(B) or (E);
B. Physically or mentally unfit for employment;
NOTE: If not evident, medical certification is required. In lieu of a doctor’s statement, statements from nurses, nurse practitioners, social workers or medical personnel may be sufficient.
C. Receiving temporary or permanent disability benefits issued by governmental or private resources;
D. Pregnant;
E. Subject to and complying with a TANF or unemployment compensation system work requirement;
F. A student, regardless of age, who is enrolled at least half time in any recognized school, training program, or institution of higher education;
G. Caring for an incapacitated person who cannot provide their own care;
H. Regularly participating in a substance use disorder treatment program meeting the requirements of Title XIX of the Public Health Service Act (42 U.S.C. 300x et seq.);
I. An Indian or an Urban Indian as defined in paragraphs (13) and (28) of section 4 of the Indian Health Care Improvement Act or California Indian as defined in section 809(a) of the Indian Health Care Improvement Act;
J. A resident of a Maine geographic area (city, town, plantation, unorganized territory, township or reservation) listed in Section 999-2.
An ABAWD who is denied eligibility under this provision can regain eligibility if, during a 30-day period, the ABAWD:
A. Works 80 or more hours;
NOTE: If self-employed, the ABAWD must be employed for 80 hours or more and must receive earnings at least equal to state or federal minimum wage, whichever is higher, multiplied by 80 hours.
B. Participates in and complies with the requirements of a work program under the Job Training Partnership Act (JTPA) or a work program under the Trade Adjustment Assistance Act (TAA) for at least 80 hours;
C. Participates in and complies with the requirements of an employment training program operated by the State or political sub-division of the State, other than a job search program or a job search training program, for at least 80 hours, or participates in and complies with the requirements of a workfare program or volunteer community service for a monthly maximum of the value of the household benefit divided by state or federal minimum wage, whichever is higher.
Hourly requirements of a workfare program or volunteer community service are determined by dividing the SNAP household benefit allotment by state or federal minimum wage, whichever is higher rounded down to the nearest dollar. The total number of monthly required hours may be met by the ABAWD individually or collectively by the members of the SNAP household. Pursuant to Section 20(c) of the Food and Nutrition Act, no member will be required to work in any workfare or volunteer position to the extent that such work exceeds in value the SNAP allotment to which the household is otherwise entitled. In addition, no member may be required to work more than thirty hours per week when the required workforce or volunteer hours are combined with any other compensated work performed that week.
As an example, if the SNAP household benefit is $150 per month, and the relevant minimum wage is $15.00 per hour, the hourly requirements would not exceed 10 hours per month.
An ABAWD who regains eligibility remains eligible as long as they work 20 hours per week or participates in a work training program, workfare, or volunteer community service subject to the requirements above.
An individual ABAWD who regains eligibility for SNAP benefits subject to the requirements above then loses their job, work training program, workfare, or volunteer community service position remains eligible to receive SNAP benefits, if otherwise eligible, for an additional period of three consecutive months without working or being in work training program, workfare program, or volunteer community service.
Any additional three-month extension period of eligibility begins on the date the individual first notifies the state that they have lost their job; work training program, workfare, or volunteer community service position. If the individual notifies the state of the loss in a prorated month, the period begins on the first day of the next month.
This additional three-month period of eligibility is available to an ABAWD only once in any 36-month period. However, there is no limit on the number of times an individual may regain and maintain eligibility by fulfilling the work requirement.
Repealed December 2021
All households have the right to file an application for SNAP benefits. Households are encouraged to file the application the same day they express an interest in applying. SNAP benefits will be calculated from the date of application (Section 999-1).
A. To start the application process, the requesting household must file an application, and at minimum:
(1) Provide the applicant's name and address; and
NOTE: The address need not be a specific street address; i.e., an individual experiencing homelessness may simply list a town or region of the state.
(2) sign the application.
B. TANF applicants are given the opportunity to apply for SNAP benefits at the same time they apply for TANF.
C. SSI applicants/recipients, including those residing in public institutions (Section 999-1), are allowed to apply for SNAP through the Social Security Office. The Social Security Office shall forward all completed SNAP applications to the Department for eligibility determination. The Department shall screen applications for completeness, verification, and expedited service. A second interview by the Department is not required.
D. Maine residents in a state or county correctional facility within Maine are allowed to apply for SNAP within 30 days prior to their anticipated release date.
Individuals cannot be included as members in more than one SNAP household in the same month. This restriction also applies to individuals moving from one state to another.
Dual participation in SNAP and the Food Distribution Program on Indian Reservations (FDPIR) is prohibited. (See Section 999-1, page 3 for additional information.)
EXCEPTION: Individuals who reside in shelters for battered persons (Section 444-6).
The Department shall provide applications to individuals who request them the same day they are requested.
The Department shall assist in completion of applications upon request.
The Department shall interview a responsible member of the household or an authorized representative as detailed in Section 222-4.
The Household must verify information as detailed in Section 222-5.
The Department shall process necessary documents to authorize receipt of SNAP benefits.
NOTE: The household may, at any time, voluntarily withdraw the application. The Department shall document in the case record that the household wanted to withdraw and, if appropriate, the reason for withdrawal.
F. To determine eligibility, the application form and applicable supplements must be completed and signed. If the household refuses to cooperate in any of the steps above, the application is denied at the time of refusal. For a determination of refusal to be made, the household must be able to cooperate, but clearly demonstrate that they will not take actions they can take and that are required to complete the application process;
G. The Department shall determine the household to be ineligible if they refuse to cooperate in any subsequent review of their eligibility.
Once denied or terminated for refusal to cooperate, the household is not eligible until they cooperate.
The following households, including residents of centers for the treatment of Substance Use Disorders and residents of group living arrangements, are entitled to expedited services:
A. households with gross monthly income less than $150.00, and with liquid assets of $100.00 or less;
B. households whose combined monthly gross income and liquid resources are less than the household's monthly rent/mortgage and the appropriate standard utility allowance;
C. households of migrant farmworkers who meet the definition of "destitute."
"Destitute" means that the household's only income for the month of application was received prior to the date of application and the income was from a source which has been terminated; or the household's only income for the month of application is from a new source of income of more than $25.00 will not be received by the 10th day after the date of application.
Migrant farmworker households who meet this definition of "destitute" shall have their eligibility and benefit level calculated for the month of application by considering only income which is received between the first of the month and the date of application.
A. Prior to issuance of any benefits, the applicant's identity shall be verified through available documents or a collateral contact.
B. If all necessary additional verification has been provided, SNAP benefits shall be authorized the day the application was filed.
NOTE: For a household which is otherwise eligible for expedited service but was denied or terminated for refusal to cooperate with a Quality Control reviewer, see Section 222-5.
C. If not all necessary additional verification has been provided by the next work day, the Department shall postpone verification and authorize benefits before the close of business.
The required verifications must be provided before the Department may authorize another month's allotment.
NOTE: Expedited service does not apply to a renewal form received before the end of a household's current certification period. However, a renewal form received after the household's certification period ends is entitled to expedited service if otherwise eligible for such service.
1. Applicant - The person in whose name the application is made and in whose name the FS coupons will be mailed.
2. Authorized Representative - A responsible non-household member, designated by the head of the household, or another responsible adult member of the household, to act on behalf of the participating household.
NOTE: With the exception of residents of drug and alcohol treatment centers, an authorized representative must be designated in writing by a responsible household member.
An authorized representative must be aware of relevant household circumstances.
WHO CANNOT BE AN AUTHORIZED REPRESENTATIVE
1. State employees involved in the certification and/or issuance process;
2. retailers who are authorized to accept FS coupons;
3. individuals disqualified for an intentional program violation during their disqualification period, unless no one else is available.
The person interviewed may be any responsible household member or an authorized representative.
Households must have telephone interviews prior to certification, except for the following circumstances:
A. The Department shall process all applications and annual eligibility reviews without an interview until March 31, 2023 unless —
(1) the household requests an interview,
(2) there is unclear information on the application or renewal form, or
(3) the household would be determined to be ineligible based on information provided on the application or renewal form.
B. Households are not required to have face-to-face interviews with Office for Family Independence (OFI) staff for applications or annual eligibility reviews.
C. Households will be scheduled for face-to-face interviews at (OFI) regional offices or available itinerant sites, if requested by the household or their authorized representative.
D. Households which have no earned income and in which all adult members are elderly and/or have disabilities are not required to complete an interview at annual eligibility review unless —
(1) there is unclear information on the renewal form, or
(2) the household would be determined to be ineligible based on information provided on the renewal form.
The Department shall conduct an interview if the household requests one.
A. All interviews must be scheduled as promptly as possible to ensure that eligible households receive benefits within the appropriate time limits for processing.
B. In the case of applications received from residents of correctional facilities (Section 222-1), a telephone interview may be completed prior to release at the request of the applicant. Absent a request from the applicant, the Department may not schedule an interview date prior to the anticipated release date.
C. If the household fails to complete the first scheduled interview, the Department shall notify the household in writing that they are responsible for re-scheduling the interview. If the household contacts the Office for Family Independence (OFI) within the 30 day application period, the Department shall schedule a second interview. If, after 30 days from the date of application (Section 999-1), the household has failed to complete an interview, the Department shall deny the application.
D. During the interview, the Department shall advise the household of their rights and responsibilities and the consequences of failure to comply with program requirements. The Department shall provide written notice of rights and responsibilities and the consequences for failure to comply with program requirements at each determination whether or not an interview has been conducted.
Recipients cannot be required to come into the office for a face-to-face interview during a certification period; however, the Department may request an interview in instances of information that is contradictory to information known to or received by the Department. The Department shall give the household ten days to respond to the request to clarify the contradictory information. Failure to resolve the contradiction results in closure procedures for failure to resolve the contradiction, not for failure to complete the interview.
Certain financial and non-financial information must be verified to ensure accuracy.
EXCEPTION: Categorically Eligible Households (Section 444-8).
Any of the following items that are reported by the household, must be verified:
Noncitizen Status (Section 111-2),
Identity (Section 111-3),
Maine Residency (Section 111-3),
Social Security Number (Section 111-4),
Current Earned and Unearned Income or lack thereof (Section 555-2 and 555-3),
Utility Expenses if the household is not eligible for a Standard Utility Allowance (Section 555-5),
Deductible Medical Expenses (Section 555-5),
Deductible Legally Obligated Child Support Payments (Section 555-5),
I. Dependent Care Expenses (Section 555-5), and
J. Meeting the definition of "Individuals with Disabilities" (Section 999-1).
Information that is contradictory to information known to or received by the Department or is otherwise considered questionable as defined in Section 999-1 and may affect eligibility or benefit levels, including separate household status (Section 111-1 (2)(D)) and the proration of lottery winnings (Section 444-12).
A. Documentary evidence is used as the primary source of verification for all items except residency and household size. Some examples of documentary evidence are wage stubs, rent receipts, and utility bills. Acceptable verification is not limited to any single type of document.
B. Whenever documentary evidence is insufficient to make a firm determination of eligibility or benefit level, or cannot be obtained, a collateral contact may be required. Generally, the Department shall rely on the household to provide the name of any collateral contact. The household may ask for help in designating a collateral contact.
When the collateral contact, designated by the household, cannot provide an accurate third party verification, the Department shall do one of the following:
(1) designate another collateral contact;
(2) ask the household to designate another collateral contact; or
(3) ask the household to provide an alternative form of verification.
NOTE: The Department is responsible for obtaining verification from acceptable contacts. A collateral contact is an oral confirmation of a household's circumstances by a person outside the household. The contact may be made by the Department either in person or by telephone. The Department shall not require written statements by collateral contacts as a condition of eligibility. Some examples of acceptable collateral contacts include employers, lessors, social service agencies, and neighbors who can be expected to provide accurate third-party verification.
Prior to making any collateral contact, the Department shall inform the household of the proposed contact, what information is required, and why the contact is needed.
Households must be provided a clear notice of their right to withdraw their application if they do not want the Department to pursue a collateral contact designated by the Department.
The Department shall document evidence to support decisions of eligibility and/or benefit levels, the reasons for questioning non-mandatory items, the need to make collateral contacts, and the reasons for not accepting an applicant’s designated collateral contact.
The household has the primary responsibility for providing verification to support statements made on the application. The Department shall assist the household in obtaining this verification. The household is not required to present verification in person. The Department shall accept any reasonable proof provided by the household and shall be primarily concerned with how adequately the verification proves the statement on the application form. When all other sources of income verification are unavailable, the amount to be used must be based upon the best available information.
The same verification procedures that are used for initial application are used in all subsequent eligibility and benefit level decisions. The verification requirements at annual eligibility review are detailed in Section 666-9(5). The verification requirements for changes during the certification period are detailed in Section 666-6.
The Department will deny or close an application or case when verification is not provided due to refusal or failure to provide verification. For a determination of refusal to be made, the household must be able to cooperate, but clearly demonstrate that they will not take actions that they can take and that are required to complete the certification process. For example, to be denied for refusal to cooperate, a household must refuse to be interviewed, not merely fail to complete it. If there is any question as to whether the household has merely failed to cooperate the household must not be denied or closed based on refusal.
If the household refuses or fails to provide verification, the Department shall deny the application, unless there is good cause (Section 999-1).
If the household is receiving benefits and refuses or fails to provide verification, the Department shall close the case, unless there is good cause (Section 999-1).
C. The household is not ineligible based upon a person outside the household failing to cooperate with a request for verification. Individuals considered disqualified (see list at Section 444-4) and authorized representatives (Section 222-3) are not considered as a person outside the household.
D. If a household refuses to cooperate with a Quality Control reviewer, the household shall be denied or terminated for refusal to cooperate. The household is not eligible until they cooperate with the Quality Control review or they reapply after the time limits described below. This ineligibility applies to all households, including those eligible for expedited service.
(1) If a household, which has been terminated for refusal to cooperate with a State Quality Control reviewer, reapplies after 125 days beyond the annual review period for that Quality Control sample month, they may be found eligible, but each eligibility factor must be verified, regardless of whether or not the information is contradictory to information known to or received by the Department.
(2) If such a household reapplies after 125 days from the end of the annual review period for that Quality Control sample month, and the household is eligible for expedited service, the household shall be provided benefits based on the expedited service processing requirements, including the provision that only identity must be verified. However, before the household may receive an issuance not processed under expedited service requirements, the household must provide verification of all eligibility requirements.
(3) Verification of all eligibility requirements refers to any household circumstance that could affect eligibility. Required verification is not limited to those items required at the time of initial application or at annual eligibility review. Items such as household composition, citizenship or eligibility for a standard utility allowance that would normally only be verified unless contradictory to information known to or received by the Department, must be verified in these cases.
(4) If a household which has been terminated for refusal to cooperate with a Federal Quality Control reviewer reapplies after 9 months beyond the annual review period for that Quality Control sample month, it may be found eligible but each eligibility factor must be verified.
NOTE: The annual review period refers to the federal Quality Control review period and runs from October 1 through September 30.
E. Where verification is incomplete, the Department shall provide the household with a written statement of required verification and an offer to assist in obtaining it. The Department shall allow the household at least ten days from the date of the initial request for the particular verification to provide the missing verification.
F. When information from another source contradicts statements made by the household, the Department shall give the household at least 10 days to resolve the discrepancy.
G. When the household fails to provide verification required to establish a deductible expense or income exclusion, the Department shall determine eligibility without the deduction or exclusion. The Department shall not deny or terminate benefits for failure to provide such verification.
An opportunity to participate includes the authorization of benefits and access to those benefits through an EBT card.
The Department shall give eligible households that complete the initial application process an opportunity to participate as soon as possible but no later than 30 calendar days following the date of application (Section 999-1). In instances where a card must be ordered for the household, authorization any later than the 27th day from the date of application, will not provide the household an opportunity to participate within the 30 day standard.
NOTE: The Department will mail a decision or card to the designated address of a participant in the Address Confidentiality Program (ACP) within the same timeframe consistent with this section. The administrators of the ACP will then forward the mail to the ACP participant. Therefore, the ACP participant might experience delays in receiving decisions and cards.
The Department shall send households that are determined to be ineligible a notice of denial as soon as possible but not later than 30 days following the date of application. If the household fails to complete a scheduled interview and makes no effort to reschedule the interview or pursue the application, the Department shall send a notice of denial on the 30th day following the date of application.
In cases where the interview was conducted and all necessary verification was requested on the date of application, the Department shall send a notice of denial no sooner than the tenth day or later than the 30th day if the household was provided assistance as outlined in Section 222-5, but failed to provide the requested verification.
If the Department does not determine eligibility and provide an opportunity to participate within 30 days following the date of application, the cause of the delay is determined using the following criteria:
A. A delay is considered the fault of the household if they have failed to complete the application process and the Department has taken all of the required actions to assist the household. The following actions must have been taken by the Department before a delay can be considered the fault of the household:
For failure to complete the application, the Department must have offered or attempted to offer assistance in its completion.
For failure to comply with work registration requirements, the Department must have informed the household of the need to register members and the household must have been given at least ten days from the date of such notification to register these members.
Where verification is incomplete, the Department must have offered assistance as outlined in Section 222-5 and the household must have been allowed sufficient time to provide the missing information (at least ten days from the date of the initial request for the particular verification).
For failure to complete an interview, the Department must have attempted to reschedule the initial interview within 30 days following the application date by sending a notification of missed interview (NOMI) to the household informing the household it missed the interview appointment and that it is the household’s responsibility to contact the Department to reschedule the interview.
NOTE: If the household failed to complete the first scheduled interview and a subsequent interview is postponed at the household's request or the household cannot otherwise be rescheduled until after the 20th day but before the 30th day, the household must complete the interview, bring verification, and register members for work/training by the 30th day. Otherwise, the delay is the fault of the household. If the household failed to complete the first scheduled interview and a subsequent interview is postponed at the household's request until after the 30th day the delay is the fault of the household. If the household missed both scheduled interviews and requests another interview any delay is the fault of the household.
B. Delays that are the fault of the Department include, but are not limited to, those cases where the Department failed to take the actions described in Subparagraph A, above.
Actions to be taken on processing delays--
Delays beyond the 30th day--
(a) If, by the 30th day, further action cannot be taken on the application due to the fault of the household, eligibility for benefits for the month of application is lost. The Department shall send the household a notice of denial which advises them that if the required action is taken within 60 days following the application date a new application is not necessary. If the household is found eligible, benefits will be authorized from the date the household takes the required action.
(b) Whenever a delay in the initial 30 day period is the fault of the Department, it shall take action immediately to correct the situation.
If the delay is solely the result of the Department not allowing the household 10 days prior to the 30th day to provide verification of noncitizen status, the Department shall issue benefits for the month of application and the current month on the 30th day.
(ii) In all instances, the Department shall notify the household by the 30th day—
a) that their application is being held pending, and
b) action they must take to complete the application process.
(iii) If the household is found to be eligible during the second 30 day period, eligibility must be determined back as far as the date of application.
Delays beyond the 60th day--
If the Department is at fault for not completing the application process by the end of the second 30 day period, and the case file is otherwise complete, the Department shall continue to process the original application until an eligibility determination is reached. If the household is determined eligible, and the Department was at fault for the delay in the first 30 day period, eligibility must be determined back as far as the date of application.
If, the initial delay was the household's fault, eligibility must be determined back as far as the date the household took the required action. The original application may be used to determine the household's eligibility in the months following the 60 day period.
If the Department is at fault for not completing the application process by the end of the second 30 day period but the case file is not complete enough to make an eligibility determination, the Department shall continue to process the original application.
If the household is at fault for not completing the application process by the end of the second 30 day period, the Department shall deny the application and the household is required to file a new application if they wish to participate. The household is not entitled to any lost benefits even if the delay in the initial 30 day period was the fault of the Department.
EXCEPTION: Expedited services (Section 222-2).
When a delay is the fault of the Department, the Department shall--
A. not deny the application until--
sufficient information is received to render a decision, or
the household fails to comply with a requirement;
and
B. take prompt action to process the application;
C. determine eligibility back to the date of application; and
D. if the household is eligible, authorize benefits back to the date of application or the date the household takes the required action per the standards established in (3)(C) above.
A. When a delay is the fault of the household, the Department shall deny the application.
B. If the household takes the required action within 60 days of the date of application, a new application is not necessary. The Department shall determine eligibility and if the household is eligible authorize benefits back to the date the household takes the required action.
After processing an application, the Department shall—
1. send a Notice of Decision; and
2. determine eligibility back to the date of application (Section 999-1) or the date the household takes the required action per the standards established in Section 222-6(3)(C).
A. If the household is eligible—
(1) The Department shall authorize benefits.
(2) The certification period is established per Sections 666-5 or 666-8.
B. If the household is ineligible, the Department shall send a notice explaining the reason(s) for denial.
NOTE: The annual eligibility review process is covered in Section 666-9.
All assets of all household members, and disqualified individuals are counted with the exceptions found in Section 333-2. The value of assets, except for licensed vehicles, is the equity value (fair market value less encumbrances).
NOTE: Fair market value is the price a property would bring on the open market, assuming an informed buyer will buy, but is not compelled to buy; and an informed seller will sell, but is not compelled to sell. “Fair market value” of real property may be established by either the testimony of competent real estate appraisers or town tax appraisal at 100% valuation rate, at the Department’s option.
A. Households that qualify as Categorically Eligible Households (Section 444-8) have no asset limit.
B. Households that do not qualify as Categorically Eligible Households and have no members age sixty or over nor a member with disabilities (according to the definition of ”Individuals with Disabilities” (Section 999-1) provided in these Rules) have a countable asset limit found in Section 999-3 Chart 9. These households with countable assets exceeding this limit are not eligible for federally funded SNAP.
C. Households that do not qualify as Categorically Eligible Households but have a member age sixty or over or a member with disabilities (according to the definition of “Individuals with Disabilities” (Section 999-1)) have a countable asset limit found in Section 999-3 Chart 9. These households with countable assets exceeding this limit are not eligible for federally funded SNAP.
D. Households that do not qualify as Categorically Eligible Households and would be eligible for federally funded SNAP except that their countable assets exceed the limit are eligible for state funded SNAP.
A. Assets held jointly between persons residing in shelters for battered persons and the individual from whom they are fleeing are not counted if agreement by that individual is required to access its value. (See Section 444-6).
B. For jointly owned vehicles, see Section 333-3 page 1.
C. Otherwise, if the household demonstrates that they have access to only a portion of the asset, that portion is counted toward the household's assets.
Joint bank accounts are assumed to be owned by the household unless they present convincing evidence that a non-household member has contributed all, or part, of the money. That portion proved to have been contributed by a non-household member is not counted.
A. Liquid Assets
Cash, crypto currency, checking, savings, Christmas Club accounts, stocks, bonds, credit union shares. Non-recurring lump sum payments, Certificates of Deposits (C.D.s), etc.
B. Non-Liquid Assets
Personal property, licensed and unlicensed vehicles including recreational vehicles (boats, snowmobiles, etc.), buildings and land, recreational property, and non-fungible assets.
The value of the following assets are not counted. (These assets are considered “excluded”).
A. the home in which the household lives and the surrounding lot, if not separated by property owned by someone else,
B. the home and lot which is temporarily unoccupied because of employment, job training, illness, or disaster if the household intends to return,
C. the lot on which the household plans to build, or is building their primary residence if the household does not already own (or is buying) their home,
D. vehicles used as the household's home,
E. assets with cash value not accessible to the household, such as:
(1) property in probate, or property which is inaccessible due to legal action;
EXCEPTION: this exclusion does not apply to jointly owned vehicles if the household member has possession of, or use of, the jointly owned vehicle. (See Section 333-3.)
(2) real property which the household is making a good faith effort to sell at a reasonable price;
NOTE: A "good faith effort to sell" must be verified through documentation that: the property is offered for sale in a major newspaper, through a real estate broker, or other comparable venue; and the household has not declined a reasonable offer.
(3) installment contracts for the sale of property (including vehicles), if the agreement is producing income consistent with its fair market value. Fair market value and consistent income may be determined by contacting local realtors, assessors, etc. Treatment of income from installment contracts is found in Section 555-3.
(4) certain jointly held assets (Section 333-1(3)) that cannot be subdivided and the joint owner will not agree to sell;
(5) irrevocable trusts when:
(a)The agreement is not likely to cease;
(b) No household member has power to revoke or change it;
(c) The trustee is either a court, institution, etc. not under control of a household member or is an individual appointed by a court which has imposed limitations on the use of funds;
(d) Investments made on behalf of the trust do not involve or assist any business or corporation under the direction or influence of a household member; and
(e) The funds held in trust—
(i) were established by a non-household member, or
(ii) are used solely for trust investments or to pay the educational or medical expenses of beneficiaries.
F. non-liquid assets that cannot be sold or disposed of for a significant return.
The sale or disposition of a resource is not considered to provide a significant return if it is unlikely to yield $1,500 or more, after estimated costs of sale or disposition and taking into account the ownership interest of the household.
Exceptions:
(1) vehicles, and
(2) homes, including mobile homes, used primarily for vacation purposes.
G. household goods - such as furniture, appliances, and gift cards;
H. personal effects - such as clothing, jewelry and non-fungible assets;
I. prepaid funeral contracts, burial space, and the value of one bona fide funeral agreement per household member;
J. life insurance;
K. pension funds;
L. taxed-preferred retirement accounts, as described from the Internal Revenue Service (IRS) code, below:
(1) Section 401, Traditional Defined- Benefit Plan
(2) Section 401(a), Cash Balance Plan
(3) Section 401(a), Employee Stock Ownership Plan
(4) Section 401(a), Keogh Plan
(5) Section 401(a), Money Purchase Pension Plan
(6) Section 401(a), Profit-Sharing Plan
(7) Section 401(a) ,Simple 401(k)
(8) Section 401(a) ,401(k)
(9) Section 403(a), 403(a)
(10) Section 403(b),403(b)
(11) Section 408 IRS, Individual Retirement Arrangement (IRA)
(12) Section 408(p), Simple retirement account IRA
(13) Section 408(k), Simplified Employee Pension Plan (SEP)
(14) Section 408A IRS, Roth IRA
(15) Section 408A IRS, myRA
(16) Section 457(b), Eligible 457(b) Plan
(17) Section 501(c ), 501(c )18 Plan
(18) Section 8439 of Title 5 USC, Federal Thrift Savings Plan
M. vehicles which are totally exempt (Section 333-3);
N. income producing real property - if the property is annually producing income consistent with its fair market value, even if only used on a seasonal basis;
O. tools and equipment necessary for employment - even if the person is not currently employed, the tools and equipment need not be producing income consistent with the fair market value;
P. Property, including licensed vehicles, essential to self-employment farming for one year from the date self-employment farming was terminated.
Q. government payments - to restore a home damaged in a disaster, provided the funds are restricted to this purpose;
NOTE: Payments from private insurance settlements are counted.
R. assets which have been prorated as income, such as -
(1) student income from grants and loans;
(2) self-employment income;
(3) contract income;
S. livestock - used to produce income or intended for family consumption;
T. Indian lands - held jointly with the Tribe;
U. assets excluded by Federal statute including, but not limited to -
(1) payments excluded by Congressional action (examples - the Maine Indian Land Claims Settlement or The Agent Orange Settlement Fund),
(2) payments to Indian Tribal members regarding sub-marginal land held in trust by the U.S.,
(3) The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) benefits,
(4) reimbursement from Uniform Relocation Assistance and Real Property Acquisition Policy Act of 1970,
(5) payments received from The Job Training Partnership Act (JTPA),
(6) payments from LIHEAP (Section 999-1),
(7) Housing and Urban Development (HUD) retroactive tax and utility cost subsidy; and
(8) Achieving a Better Life Experience (ABLE) accounts, established under Sec. 529A of the Internal Revenue Code of 1986.
V. The assets of any household member who receives Supplemental Security Income (SSI) or Temporary Assistance for Needy Families (TANF) or Parents as Scholars (PaS);
W. A federal earned income tax credit received either as a lump sum or as payments under section 3507 of the Internal Revenue Code for the month of receipt and the following month for the individual and that individual's spouse;
X. Any federal, state, or local earned income tax credit received by any household member for 12 months, provided the household was participating in SNAP at the time they received the earned income tax credit and provided the household participates continuously during that 12-month period. Breaks in participation of one month or less due to administrative reasons, such as delayed recertification, shall not be considered as nonparticipation in determining the 12-month period;
Y. Matching awards of Savings Offer Success (SOS) made by Rural Opportunities, Inc. (ROI) to households that participate in their program;
NOTE: The individual’s contribution are counted.
Z. Funds in the Department of Housing and Urban Developments (HUD) Family Self-Sufficiency Program (FSS) escrow accounts;
AA. Family Development Accounts or Separate Identifiable Accounts set up as authorized by state law 20-A M.R.S. § 10982 of up to the $10,000 cap and any accrued interest;
BB. Federal Thrift Savings accounts as provided in Sec. 8439, Title 5, U.S.C.; and
CC. Education savings accounts established under Sec. 529 (qualified tuition program), and Sec. 530 (Coverdell education savings) of the Internal Revenue Code of 1986.
A. Excluded funds kept in a separate account are exempt for an unlimited time.
B. Excluded funds that are deposited in an account with other funds are only exempt for six months from date they are co-mingled.
EXCEPTION: Earned income tax credits excluded in Section 333-2(1)(X) continue to be excluded for 12 months even if they are co-mingled with other funds.
C. Student grants, deferred loans and self-employment funds are not counted as assets for the period of time they have been prorated as income. (See Section 444-8.
The fair market value and/or equity value of all nonexempt vehicles is counted. Encumbrances are not considered in determining fair market value.
EXCEPTIONS:
If NADA book value does not apply (antique, custom or classic cars), a dealer appraisal will be required. If the car is not listed in the NADA Book or recipient claims the car is in less-than-average condition, recipient value may be accepted, unless questionable. If value will affect eligibility, require verification from a knowledgeable source.
Vehicles that are jointly owned by a household member and a non-household member who does not live with the household are excluded from countable resources provided that the vehicle is unavailable to the household member because the household member does not have possession of, or use of, the vehicle and the household member is unable to sell the vehicle because the signature of the co-owner is needed and he or she will not sign.
Inability to sell the vehicle is only one factor. If the household has use of the vehicle, it is not excluded due to joint ownership. If the household is not using the vehicle,
but has possession of the vehicle, it is not excluded due to joint ownership.
NOTE: The fair market value of vehicles is found in NADA Book under Average Trade-in Value (excluding optional equipment, mileage or special equipment for disabled).
NOTE: A household is not limited to a certain number of vehicles per household size or per the number of licensed drivers. Each vehicle is to be evaluated separately.
Fair Market Value Test (Average Trade-in Value) Fair Market Value - $4,650.00 Excess Value | Equity Test Fair Market Value - Amount owed Equity Value Producing income Includes vehicles needed to do a particular job. Includes vehicles deemed necessary by the employer. It does not include vehicles necessary for commuting to and from employment. | DO NOT count | DO NOT count Used as a home | DO NOT count | DO NOT count Transporting a physically disabled household member If disability is not evident, or if the disabled member does not receive disability payments, written proof of impairment must be produced by a physician. | DO NOT count | DO NOT count Carrying heating fuel or water When such heating fuel or water is anticipated to be the primary source of fuel and water for the household during the certification period. | DO NOT count | DO NOT count Value is inaccessible (sale would produce less than $1500) | DO NOT count | DO NOT count One vehicle per household | DO NOT count | DO NOT count One licensed vehicle per adult member | USE this Rule | DO NOT count Commuting to employment or job training or seeking employment | USE this Rule | DO NOT count Additional licensed vehicles | Count the Greater of Fair Market or Equity Value Unlicensed vehicles | DO NOT count | USE this Rule
EXCEPTION: Vehicles on Indian Reservations not required to be licensed will be evaluated the same as licensed vehicles.
GENERAL RULE - Disqualify for up to one year households that have knowingly transferred assets for the purpose of qualifying for FS benefits.
Disqualification Applies If the Assets were Transferred
in the three-month period prior to application.
OR
any time during the certification period.
Disqualification Does Not Apply If
assets transferred would not have otherwise affected eligibility.
assets were sold or traded at or near current market value.
transfers were made between members of the same household.
OR
transfers were made for a reason other than attempting to qualify for FS, such as placing funds in an irrevocable trust fund for a child's education.
The length of the disqualification period is based on the amount the assets would have exceeded the limit if the transfer had not occurred.
DISQUALIFICATION PERIODS
Use the following chart to determine the disqualification period.
Amount in Excess of Disqualification
Asset Limit Period (Months)
$ 0 to $ 249.99 1
$ 250 to $ 999.99 3
$1,000 to $2,999.99 6
$3,000 to $4,999.99 9
$5,000 or more 12
Noncitizens must verify Maine residency and have eligibility determined according to the rules in Section 111-2. Sponsored noncitizens have a portion of their sponsor’s income and assets counted toward their eligibility and benefit level.
A. Sponsored Noncitizen: is a person lawfully admitted for permanent residence to the U.S. for whom a person (the sponsor) has executed an affidavit of support (USCIS Form I-864 or I-864A)
B. Sponsor: A person or organization signing an affidavit or document on behalf of the noncitizen as a condition of entry.
C. Date of Entry or Admission: The date established by the Department of Homeland Security (DHS) as the date the noncitizen was admitted for permanent residence.
The Sponsor’s income and assets will not be deemed to the following individuals:
A. Noncitizens who are members of the sponsor’s SNAP household;
B. Noncitizens who are sponsored by an organization.
C. Noncitizens not required to have a sponsor under the Immigration and Nationality Act, such as refugee, parolee, individuals granted asylum and entrants from Cuba or Haiti;
D. Noncitizens who are determined to be unable to obtain food and shelter in the absence of assistance, taking into account their own income. The sponsor’s income is not counted for a (12 month period.
F. A battered noncitizen spouse, noncitizen parent of a battered child, or a child of a battered noncitizen.
The sponsor’s income is not counted for 12) months after the Department determines that the battering is substantially connected to the need for benefits, and the battered individual does not live with the batterer. After 12 months, the batterer’s income and assets will not be counted if the battery is recognized by a Court or DHS, and has a substantial connection to the need for benefits and the noncitizen does not live with the batterer;
G. Noncitizens who are children under the age of 18 regardless of when they entered the United States;
H. Noncitizens credited with 40 qualifying quarters of work (Section 111-2);
I. Noncitizens ineligible for SNAP even if other members of their household are eligible; and
J. Noncitizens whose sponsor’s income is below 130% of the FPL (Section 999-3 Chart 2).
A. The income of a sponsor’s spouse does not count toward the deeming unless the sponsor’s spouse has also signed the affidavit of support and the sponsor and their spouse live together.
If so, the spouse's income and assets are counted even if they were not married at the time the agreement was signed.
B. If a sponsor sponsors more than one noncitizen, the income and assets are divided among the number of noncitizens that are sponsored by them.
C. If a noncitizen changes sponsors after being certified for SNAP, use the new sponsor's income and assets are used to determine eligibility.
D. Money paid to the noncitizen by the sponsor is counted as income to the noncitizen, to the extent that it exceeds the income deemed from the sponsor.
E. If the noncitizen has applied for TANF and has had income and assets deemed for that program, the TANF figures are used.
Deeming of a sponsor’s income and resources continued until:
A. the noncitizen gains U.S. Citizenship,
B. the noncitizen has worked or received credit for forty (40) qualifying quarters of work, or
C. the sponsor dies.
The amount of income deemed to each sponsored noncitizen is calculated by:
A. Adding together all the earned income of the sponsor’(s),
B. Subtracting the 20% earned income deduction,
C. Adding all the unearned income of the sponsor(s),
D. Subtracting the gross monthly income limit (Section 999-3 Chart 2) for the sponsors’ family size (number of dependents who are, or could be, listed on Federal Income Tax Form), and
E. Dividing the result by the number of noncitizens sponsored.
The result is the income deemed to each sponsored noncitizen.
The assets value deemed to each sponsored noncitizen is calculated by:
A. Adding the countable assets of the sponsor and spouse,
B. Subtracting $1500.00, and
C. Dividing the result by the number of noncitizen households sponsored.
The result is the assets deemed to each sponsored noncitizen.
Both the sponsor and the noncitizen are liable for any over-issuances. The Department may establish claims against both parties, unless it can be verified that one of the parties was without fault in providing the information.
A. GENERAL RULE
(1) Self-employment income is averaged over a twelve-month period when it represents the household's largest income source anticipated for the 12-month period. This applies even when it is received in a shorter period of time.
(2) Seasonal self-employment income which is not the household’s largest income source anticipated for the 12-month period is averaged over the season.
B. VERIFICATION
Acceptable verification of self-employment income, expenses, and assets includes but is not limited to income tax returns, business records, and amortization schedules.
C. DETERMINING INCOME
(1) All gross self-employment income including the full amount of capital gains is added together. This means that a household with more than one self-employment enterprise shall have all self-employment gross income added together.
(2) All costs of producing income are added together. This means that a household with more than one self-employment enterprise shall have all self-employment costs added together.
(a) Payments on the principal of the purchase price of income producing real estate, capital assets, equipment, machinery, or other durable goods are allowed.
(b) A household deriving income from child or adult care may elect actual documented cost of meals or the current reimbursement amounts used in the Child and Adult Care Food Program (published annually in the federal register per 7 C.F.R. § 226.4(i)) as the cost of non-reimbursed meals provided to individuals.
These values can be found at https://www.federalregister.gov/documents/search?conditions%5Bterm%5D=%22Child+and+Adult+Care+Food+Program%22+%22Payment+Rates%22&order=newest.
Individuals may also request copies by writing to:
Rules Manager
Maine DHHS, Office for Family Independence
11 State House Station109 Capitol St.
Augusta, ME 04333-0011.
(c) For business use of the home expenses, see Paragraph D below.
(d) Expenses not allowed are:
(i) net losses from previous periods;
(ii) federal, state and local income taxes, retirement plans, and work-related personal expenses (transportation to and from work);
(iii) depreciation.
(3) The total costs of producing the income are subtracted from the total gross income of the self-employment enterprise(s) to arrive at the net earnings.
NOTE: The purpose of Sub Paragraphs 1 through 3 above is to arrive at the total self-employment income of the household. This process allows the loss from one self-employment enterprise to be subtracted from the gain of another self-employment enterprise within the household.
(4) The net earnings are divided by number of months over which income is averaged.
(5) Self-employment income is added to any other income received by the household.
NOTE: Losses from a farm enterprise are deducted from any other countable household income. This special consideration applies only to farms with annual gross sales of $1,000.00 or more.
D. USE OF RESIDENCE FOR SELF-EMPLOYMENT
The proportionate share of shelter costs used for self-employment purposes may be used as self-employment expenses. If the household chooses this approach—
(1) actual or Internal Revenue Service (IRS) allowed utility expenses, not the standard utility allowance, can be used as a business expense;
(2) the interest expenses and the principal of loan and mortgage payments can be used;
(3) that portion of shelter costs used as self-employment expenses cannot be used as shelter expenses. (See Section 555-5 for the effect of the self-employment expense decision on the household's allowable utility expenses.)
E. RENTAL SELF-EMPLOYMENT INCOME
(1) If at least one member of the household is actively engaged in the management of the property at least an average of 20 hours per week, this income is treated as earned income.
(2) If no member of the household is actively engaged in the management of the property at least an average of 20 hours per week, this income is treated as unearned income
(3) Income from roomers
Income from roomers as defined in Section 999-1 is always treated as earned income regardless of the number of hours the household is actively engaged in the management of the property. If a person rents out a room in their primary residence, the cost of renting out that room may be claimed as a self-employment expense.
(a) If the roomer income is listed on Federal Tax Returns, the method used for determining those expenses on the return is the method that is used for SNAP budgeting.
(b) Otherwise, this expense is determined by multiplying the costs of operating and maintaining the residence by either:
(i) the number of rooms used exclusively by the roomers divided by the total number of rooms in the residence, or
(ii) the square footage of the space used exclusively by the roomers divided by the square footage in the residence.
That portion of household expenses counted as a cost of doing business may not be counted again as a shelter expense. (See Paragraph D(3) above.)
Excluded costs shall not exceed the payments received from the roomer.
If meals are also provided, see Section 444-3.
A. All income received in the month of application prior to the application date is counted.
NOTE: Travel advances are included when a written contract stipulates the advance will be subtracted from wages. Other travel advances are treated as reimbursements.
B. Future income is budgeted when receipt is reasonably anticipated in the application month.
C. Income for the month of application must be verified.
A. GENERAL RULE
Contract income is averaged over a twelve month period when it represents the household's largest income source anticipated for the 12-month period, provided it is not paid on an hourly or piecework basis. This applies even when it is received in a shorter period of time such as sometimes occurs with teachers and other school employees.
Contract income is averaged over the period the income was intended to cover when it is not the household's largest income source anticipated for the 12-month period, provided it is not paid on an hourly or piecework basis.
B. DETERMINING ELIGIBILITY
The averaged contractual income is added to other household income. Income exclusions and deductions shall then be applied in the usual way.
GENERAL RULE - Foster care individuals (both children and adults) placed in the home of relatives (including parents and siblings) or other individuals or families by a federal, state, or local governmental foster care program shall be considered boarders. These foster care boarders and all other boarders are ineligible to participate independent of the household with whom they live. Do not count income and assets of a boarder, foster children and foster adults to determine eligibility of a household, unless the household chooses to include him/her as a member.
NOTE: When the household chooses not to include the foster person, do not include foster care payments even though they go direct to the provider household.
EXCEPTION: Consider "boarders" paying less than the Thrifty Food Plan (FS 999-3 Chart 5) as household members (FS 111-1).
DETERMINING INCOME FROM BOARDERS - Include all direct payments to the household, including contributions for meals, room and shelter.
EXCEPTION: Do not count shelter expenses paid directly to someone outside the household as income or deductions to the household. Do not count any portion of foster care payments unless the foster children or foster adults are included as members.
1. actual verified cost of providing room and meals.
NOTE: Verify these expenses only if questionable.
Count income from boarders, less the cost of doing business, as earned income to the household (FS 555-2).
NOTE: If room and board are being provided, use both the "Income From Roomers" policy at FS 444-2 and the boarder policy described here to determine room and board cost of doing business.
Household members disqualified for the following reasons are not included for benefits:
Intentional program violation (IPV) of the SNAP Program (Section 777-2)
Work registration noncompliance (non-head of household) (Section 111-5)
Job quit or voluntary reduction in work effort (Section 111-6)
Fleeing Felon (as defined in Section 999-1)
Violation of probation or parole imposed under a federal or state law (ineligible while in violation of the probation or parole condition)
Certain felons convicted of violent crimes and sexual assault if all of the following are true:
(1) They were convicted as an adult in any jurisdiction under federal or state law of:
(a) aggravated sexual abuse under 18 United States Code, Section 2241,
(b) murder under 18 United States Code, Section 1111,
(c) an offense under 18 United States Code, Chapter 110,
(d) a federal or state offense involving sexual assault, as defined in Section 40002(a) of the federal Violence Against Women Act of 1994, 42 United States Code, Section 13925(a), or
(e) an offense under a law of this State that is substantially similar to a federal offense described in this subsection;
(2) The conviction is for conduct that occurred after February 7, 2014; and
(3) The individual is not in compliance with the terms of their sentence, parole or probation or is a fleeing felon.
G. Noncitizen status (Section 111-2)
H. Inability or unwillingness to provide documentation of noncitizen status
Social security number noncompliance (Section 111-4)
An intentional program violation of another federal, state, or local welfare assistance program requirement (Section 444-10)
Time limited eligibility for able-bodied adults without dependents, ABAWD status (Section 111-7)
L. Student status (Section 444-7)
A. DISQUALIFIED MEMBERS (COUNT ALL)
If a household includes a disqualified member who is ineligible due to a SNAP IPV; noncompliance with work registration; job quit or voluntary reduction in work effort; a fleeing felon; violating a condition of probation/parole; certain felons convicted of violent crimes and sexual assault; or inability or unwillingness to provide documentation of noncitizen status, then the disqualified member’s assets, income, deductions, as well as the family size of the remaining household are calculated as follows:
(1) Assets – 100% of the disqualified member’s assets are counted toward the asset level of the household.
(2) Income – 100% of the disqualified member’s income is counted toward the income level of household. The disqualified member is not counted as a household member when determining the standard deduction for the household. The assets and income of the sponsor and the sponsor's spouse of an ineligible sponsored noncitizen are not counted.
(3) Deductible Expenses – The entire household’s allowable earned income, medical, dependent care, child support, and excess shelter deductions (including disqualified members), are applied to the remaining household members.
(4) Number in Household – Benefits for the household are not increased as a result of the exclusion of one or more household members because of the disqualification. Disqualified member(s) are not included in the household size for the purposes of:
(a) Assigning a benefit level to the household; or
(b) Comparing the household's monthly income with the income eligibility standards; or comparing the household's resources with the resource eligibility limits.
B. DISQUALIFIED MEMBERS (PRORATED)
If a household includes a disqualified member who is ineligible due to social security noncompliance; an intentional program violation of another public assistance program requirement; time limited ABAWD status; noncitizen status (except for those noncitizens, disqualified because of their status, listed under “exceptions” below), then the disqualified
member’s assets, income, deductions, as well as the family size of the remaining household are calculated as follows:
(1) Assets - 100% of the disqualified member’s assets are counted toward the asset level of the household.
(2) Income – A pro rata share of the disqualified member(s)’s income is counted as income to the remaining members according to the “CALCULATION” below. The disqualified member is not counted as a household member when determining the standard deduction for the household.
CALCULATION
(a) SUBTRACT: Allowable exclusions from disqualified member’s income (including the 20% disregard).
(b) DIVIDE: The remaining income by the number of household members (including disqualified member(s)).
(c) SUBTRACT: The income allocated to the disqualified member.
(d) COUNT: The remaining sum is added to eligible household’s income.
(3) Deductible Expenses – A pro rata share of the disqualified member’s deductible expenses are counted as expenses to the remaining members according to the following calculation:
CALCULATION
(a) ADD: All allowable child support payment, shelter and dependent care expenses which are either paid by, or billed to, the disqualified member(s)
(b) DIVIDE: By number of household members (include disqualified member(s))
(c) SUBTRACT: The deductible expenses allocated to the disqualified member(s).
(d) COUNT: The remaining sum is counted as an allowable expense for the remaining household members.
(4) Number in Household - Disqualified member(s) are not included in the household size for the purposes of:
(a) Assigning a benefit level to the household;
(b) Comparing the household's monthly income with the income eligibility standards; or
(c) Comparing the household's resources with the resource eligibility limits.
(5) EXCEPTIONS:
The income, assets, and expenses of non-citizens disqualified because of one of the following noncitizen statuses, are treated according to the procedure under the DISQUALIFIED MEMBER (COUNT NONE), Subparagraph C, below:
(a) Certain individuals who have been lawfully admitted for permanent residence (Section 111-2(3)(B)(3));
(b) Asylees granted and retaining asylum pursuant to 8 U.S.C. § 1158;
(c) Refugees granted and retaining refugee status pursuant to 8 U.S.C. § 1157;
(d) Certain individuals who have been paroled into the U.S. for urgent humanitarian reasons or significant public benefit (Section 111-2(4)(C)(2)(b));
(e) Individuals who are not being deported because they meet the conditions of —
8 U.S.C. § 1231(b)(3); or
8 U.S.C. § 1253(a)(3).
(f) Special agricultural workers admitted for temporary residence under 8 U.S.C. § 1160;
(g) Certain individuals who have been battered and certain relatives of theirs granted and retaining immigrant status under the conditions of 8 U.S.C. § 1154 (a)(1)(A)(iii), (iv), (v)(I)(cc), (vii), 1154(a)(1)(B)(ii), (iii), or (iv)(I)(cc);
(h) Individuals meeting the definition of “victim of a severe form of trafficking in persons” as defined in 22 U.S.C. § 7105(b)(1)(C) or meeting all but the age requirement; and
(i) The spouse, minor child, parent or sibling of such an individual who holds a T Visa.
C. DISQUALIFIED MEMBERS (COUNT NONE)
If a household includes a disqualified member who is ineligible due to student status, boarders, foster care individuals, roomers, live in attendants, or due to a noncitizen status listed under Subparagraph B(5) above or any other reason not listed in Subparagraphs A or B, above, their assets, income, and expenses are not counted, except as indicated below.
(1) Income – Cash payments from the disqualified member to the remaining of the household are considered income. Vendor payments are not considered income.
When the earned income of one or more eligible household members and the earned income of a disqualified member are combined into one wage, the income of the eligible household members shall be determined as follows:
If the eligible household's share can be identified, that portion is counted as earned income.
If the eligible household's share cannot be identified, the earned income is prorated among all those whom it was intended to cover and that portion prorated to the eligible household members is counted.
CALCULATION – See DISQUALIFIED MEMBERS (PRORATED), Income (Subparagraph B(2), above).
(2) Deductible Expenses – If expenses cannot be separated between the disqualified member and the eligible household, then the expenses are prorated evenly among the persons actually paying or contributing to the expense(s) and only the household’s pro rata share is allowed as an expense.
CALCULATION – See DISQUALIFIED MEMBERS (PRORATED), Deductible Expenses (Subparagraph B(3) above).
(3) Number in Household - Disqualified member(s) are not counted in the household size for the purposes of:
(a) Assigning a benefit level to the household;
(b) Comparing the household's monthly income with the income eligibility standards; or
(c) Comparing the household's resources with the resource eligibility limits.
Residents of centers for the treatment of substance use disorders or group living arrangements for individuals with disabilities have the same rights to notices of adverse action, fair hearing and entitlement to lost benefits as do all other SNAP households.
A. GENERAL RULE
Application for residents of centers for the treatment of substance use disorders together with their spouse and children who reside at the center must be made through an authorized representative who is an employee of the center. Residents together with their spouse and children shall have their eligibility determined separately from other residents of the facility. Each application must be for an individual household. The recipient's benefits will be controlled by the center.
The center must be certified by the State of Maine Office of Behavioral Health as providing residential treatment of individuals with substance use disorders.
A center which knowingly provides false information or does not handle benefits properly may be disqualified from participation in SNAP. Repeated occurrences shall be referred to the Senior Program Manager - SNAP, for review.
B. PROCEDURE
(1) The Department shall verify that the center is a certified treatment program as defined under the general rule.
(2) The Department shall review the rights and reporting responsibilities of the center with the center representative, including the treatment of benefits and EBT Cards when a recipient leaves the center.
(3) The Department shall process applications by using the same provisions that apply to all other applicant households, except that certification is completed through use of the authorized representative.
(4) The Department shall contact the authorized representative for any information needed. The authorized representative must agree to sign any required forms and be interviewed with the following exceptions:
(a) The Department shall process all applications and annual eligibility reviews without an interview until March 31, 2023 unless —
(i) the household requests an interview,
(ii) there is unclear information on the application or renewal form, or
(iii) the household would be determined to be ineligible based on information provided on the application or renewal form.
(b) Households which have no earned income and in which all adult members are elderly and/or have disabilities will not be required to complete an interview at annual eligibility review unless —
(i) there is unclear information on the renewal form, or
(ii) the household would be determined to be ineligible based on information provided on the renewal form.
The Department will conduct an interview if the household requests one.
(5) Benefits shall be issued and notices shall be provided in care of the authorized representative.
(6) The Department shall use appropriate budgeting procedures. (See Section 555-6.)
NOTE: If the center charges for room and board, the room expense is included in the budget as a rent expense (see Section 555-5(7)(A)(1)), but the board expense is not. If the center does not provide an itemized bill, the rent included in the budget is determined by subtracting the Thrifty Food Plan (Section 999-3 Chart 5) for the household size, from the total room and board expense.
C. WHEN A HOUSEHOLD LEAVES THE CENTER
(1) When the household leaves the center and no benefits have been spent on their behalf, the center shall provide the household with their EBT Card and full allotment for that month, regardless of what day they leave.
If benefits have already been issued and any portion has been spent on behalf of the household, and they leave the center prior to the 16th of the month, the center shall provide the household with one-half of their monthly allotment.
If the household leaves after the 16th of the month, and the benefits have already been issued and used, the household does not receive any benefits for that month.
(2) Once the household leaves the treatment center, the center is no longer allowed to act as the household's authorized representative. The center shall return to the household’s account any benefits received on behalf of households which are no longer residents of the center.
(3) It is the household's responsibility to report their new address and other changes in their circumstances to the Office for Family Independence after leaving the center.
A. GENERAL RULE
A group living arrangement for individuals with disabilities is a public or private nonprofit facility, serving no more than 16 residents (the majority of whom are SSI recipients), that is approved by the State of Maine Department of Health and Human Services.
An individual with disabilities (as defined in Section 999-1) living in an approved group living arrangement for individuals with disabilities may be eligible for benefits. The group living arrangement for individuals with disabilities shall determine whether a resident may apply on their own behalf.
If the resident applies on their own behalf, they are responsible for reporting changes in their situation to the Office for Family Independence (OFI). If the group living arrangement is acting as authorized representative, it is responsible for reporting changes in the household's circumstances, and when the household leaves the facility.
If the facility charges for room and board, the room expense is included in the budget as a rent expense, but the board expense is not. If the facility does not provide an itemized bill, the rent included in the budget is determined by subtracting the Thrifty Food Plan (Section 999-3 Chart 5) for the household size, from the total room and board expense.
B. WHEN A RECIPIENT LEAVES THE FACILITY
When the household leaves the facility, regardless of the method of application or the time of the month, the facility shall provide the resident(s) with their EBT Card (if applicable), and the departing household shall receive their full allotment if no benefits have been spent on their behalf.
If the benefits have already been issued, and any portion spent on behalf of the household and the departure is prior to the 16th of the month, the facility shall provide the household with their EBT Card and one-half of their monthly allotment. If the household leaves after the 16th of the month and the benefits have already been issued and used, the household does not receive any reimbursement.
If a group of residents have been certified as one household, and one or more depart prior to the 16th of the month, the facility will notify OFI and one half the departing residents’ share of the benefit will be transferred to their new account.
GENERAL RULE - Residents of Shelters for Battered Persons may be eligible for benefits.
“The Food and Nutrition Act of 2008, as amended (“the Act”), and Supplemental Nutrition Assistance Program (SNAP) regulations allow certain flexibilities for victims of domestic violence who are fleeing their abuser. These include:
Section 3(n)(5) of the Act: Conferring separate household status to temporary residents of shelters for battered persons;
Section 3(k) of the Act: Allowing those residents to use their SNAP benefits to purchase food from the shelter; and
7 CFR 273.3(a): Allowing duplicate participation of an individual who is a resident of a shelter for battered persons, and was a member of a household containing the person who had abused him or her.”
(USDA Guidance: Men Who are Residents of Shelters for Battered Women and Children, Dated December 18, 2014)
Food and Nutrition Services, “(FNS) finds that all provisions related to persons fleeing domestic violence shall be interpreted to apply to all victims of domestic violence, regardless of gender or sex.”
(USDA Guidance: Men Who are Residents of Shelters for Battered Women and Children, Dated December 18, 2014)
An eligible resident who has authorized the shelter management to act as authorized representative can use the benefits to purchase meals prepared at the shelter; the shelter management can then act as authorized representative to purchase food with the benefits.
1. Persons who have left a participating household containing the person who abused them may receive an additional allotment as a separate household once in a calendar month.
2. Certify persons at the shelter as a separate household on the basis of their income and assets only.
NOTE: Adjust the FS allotment of the former household based on reduced household size within the prescribed rules for adverse action.
3. If the shelter charges for room and board, the room expense is an allowable rent expense but the board expense is not. If the shelter does not provide an itemized bill, the allowable rent will be determined by subtracting the Thrifty Food Plan (FS 999-3 Chart 5) for the household size, from the total room and board expense.
Students enrolled at least half-time in post-secondary schools, colleges, universities, etc., are treated differently from other applicants and recipients.
A. In order to be eligible, such students must meet at least one of the following conditions. The requirement that one of these conditions be met in order to be eligible continues throughout the student's enrollment, including vacations. (E.g. in order to continue to be eligible for SNAP benefits, a student who is eligible because of the work study condition must meet one of the other conditions if the work study condition is not being met during summer vacation.)
(1) be 17 years old or under or 50 years old or older;
(2) be physically or mentally unable to work twenty hours per week while attending school at least half-time. In the absence of physical evidence, disability must be verified by—
(a) verification of receipt of temporary or permanent disability benefits issued by a governmental or private source or
(b) a statement from an acceptable medical or mental health source such as:
(i) a licensed physician;
(ii) a physician’s assistant;
(iii) a nurse practitioner;
(iv) a licensed osteopath;
(v) a licensed or certified psychologist;
(vi) a person authorized to provide copies of the summaries of medical records of medical institutions; or
(vii) as the disabling condition relates specifically to their field—
a) a licensed podiatrist,
b) a qualified speech-language pathologist, or
c) a licensed optometrist;
(3) be responsible for care of a household member under six years old, or when adequate child care is not available for children between six and twelve years of age to enable the student to attend class and satisfy the 20 hour work requirement or participate in a work study program (if an individual is a full time student and a sole parent with the responsibility for a dependent child under age 12 regardless of the availability of adequate child care, eligible student status is met).
NOTE: Exemption is still allowed when child care is purchased for a child under six years old;
(4) be receiving TANF/PaS;
(5) Starting January 16, 2021 and continuing through the end of any certification period that began during the COVID-19 Public Health Emergency (PHE) or within 30 days of the termination of the COVID-19 PHE, a student that has an expected family contribution of $0 as determined in accordance with 20 U.S.C. ch. 28, Subchapter IV, Part F (Helpful resources may be found by search for the relevant fiscal year EFC Formula Guide published at https://fsapartners.ed.gov/knowledge-center);
(6) be engaged in paid employment of 86 hours or more per month. If self-employed, be employed for 86 hours or more per month and receive monthly earnings averaging at least equal to the Federal minimum wage multiplied by 86 hours;
(7) be participating in a state or federally financed work study program;
(8) Starting January 16, 2021, a student need only be approved for federally financed work study. Participation is not required. This expanded eligibility is in effect for the duration of any certification period that began during the COVID-19 Public Health Emergency (PHE) or within 30 days of the termination of the COVID-19 PHE. This expanded eligibility, unlike the usual work study condition, will continue through scheduled school vacations;
(9) be participating in an on-the-job training program;
NOTE: A person is considered to be participating in an on-the-job training program only during the period of time the person is being trained by the employer (i.e., to meet this student eligibility condition, the person must continue to work; only attending classes does not meet the condition).
or
(10) be assigned to or be placed in post-secondary institution through one of the following programs:
(a) Workforce Innovation and Opportunity Act (WIOA),
(b) Supplemental Nutrition Assistance Employment and Training (SNAP E&T),
(c) the Trade Adjustment Assistance Program of the Department of Labor (for workers dislocated due to imports), or
(d) an employment and training program for low income households operated by a state or local government where one or more of the components of such program is at least equivalent to a SNAP E&T program component (e.g., 8 weeks per year job search; job search training and support activities; workfare; work experience; education program that directly enhances employability). Examples: Maine Department of Labor Competitive Skills Scholarship Program (CSSP) and Higher Opportunity for Pathways to Employment (HOPE).
NOTE: Self-initiated post-secondary institution placement during the time the person is enrolled in one of these employment and training programs is acceptable if the person’s employment and training program has a component for enrollment in an institution of higher education and that program accepts the placement.
B. Once a student enrolls in post-secondary education, they shall be considered enrolled through normal periods of attendance, vacations, and recesses until they graduate, are dismissed, drop out, or do not plan to enroll for the next normal term (summer sessions are not considered normal terms).
C. The income and assets of an ineligible student living with a household shall not be considered in determining the benefits of the remaining household members. See 444-4.
A. The individual must provide verification of student aid received. The Department shall not assume the individual is accepting all aid awarded.
B. Most federal financial aid is completely excluded as income, without regard for how the aid is spent. Calculation of allotments for students, begins by identifying the types of federal financial assistance the student will receive, and excluding all pertinent assistance as income.
C. Exclusion of Certain Federal Aid Monies
(1) Student financial assistance received under Title IV or under Bureau of Indian Affairs (BIA) student assistance programs, is not considered as income. Nor are loans provided under Title XIII Indian Higher Education Programs, Part E, Tribal Development Student Assistance Revolving Loan Program.
Examples include the following programs:
(a) Under Title IV:
(i) Basic Educational Opportunity Grants (BEOG or PELL Grants),
(ii) Presidential Access Scholarships (Super PELL Grants),
(iii) Federal Supplemental Educational Opportunity Grants (SEOG),
(iv) State Student Incentives Grants (SSIG; Maine State Incentive Grant),
(v) Federal Direct Student Loan Programs (FDSLP) (Formerly GSL and FFELP),
(vi) Federal Direct Supplemental Loan Program (provides loans to students),
(vii) Federal Direct PLUS Program (provides loans to parents),
(viii) Federal Direct Stafford Loan Program,
(ix) Federal Direct Unsubsidized Stafford Loan Program,
(x) Federal Consolidated Loan Program,
(xi) Federal Perkins Loan Program - Direct Loans to students in institutions of higher education,
(xii) Federal Work Study Funds,
(xiii) TRIO Grants (Go to organizations or institutions for students from disadvantaged backgrounds),
(xiv) Upward Bound (Some stipends go to students),
(xv) Student Support Services,
(xvi) Robert E. McNair Post-Baccalaureate Achievement,
(xvii) Robert C. Byrd Honors Scholarship Program,
(xviii) College Assistance Migrant Program (CAMP) for students whose families are engaged in migrant and seasonal farm work,
(xix) High School Equivalency Program (HEP), and
(xx) National Early Intervention Scholarship and Partnership Program.
(b) Under BIA
(i) The Higher Education Grant Program, sometimes called the Scholarship Grant Program,
(ii) Adult Education Program that provides money to adults to get a GED, attend technical schools, and for job training,
(iii) employment assistance program, and
(iv) education and training made available under separate programs like the Indian Child and Family Programs.
NOTE: Each tribe has a BIA agency that may be contacted for more information about education and training assistance. BIA student assistance is provided by the tribes, is not denoted by any particular name, and is not usually listed on institutions' financial aid statements.
(2) All grants, loans and scholarships to students made under any program administered by the U.S. Secretary of Education including, but not limited to, PELL, SEOG, Perkins, and work study are excluded. This is regardless of any portion used on actual educational costs.
(3) If a single loan, grant, or work study is funded in whole or in part (e.g. part of a student loan funded under Title IV and part under a State program) under Title IV or BIA, the total amount of that loan or grant is excluded.
D. The dependent portion of VA educational assistance is counted as income.
E. Treatment of Other Financial Aid
(1) Reimbursements for past or future expenses other than normal household expenses such as rent, mortgage, personal clothing, or food eaten at home are excluded if they are specifically earmarked for educational expenses.
Example: If an individual purchased a computer and was reimbursed for that purchase as an educational expense through the HOPE program, the reimbursement would not be counted as income. However, if the reimbursement comes from another agency and receipt is not linked to the computer being used for education, it would be countable income.
(2) Assistance which is earmarked for expenses, other than room and board, is excluded. That portion of an otherwise deductible expense covered by educational income which has been excluded is not deductible. (See Section 555-5 pg. 8.)
Example: If the HOPE program provided ongoing assistance for child care to allow an individual to complete their training or education program, the assistance would not be counted as income, nor would the portion of the child care covered by HOPE be counted as an income deduction.
(3) Other scholarships; including but not limited to, educational grants, fellowships, work study, deferred payment loans for education, and veteran's educational benefits; are considered income unless:
(a) they are awarded to a person enrolled at a recognized institution of post-secondary education, at a school for individuals with disabilities, in a vocational education program, or in a program that provides for completion of a secondary school diploma or obtaining the equivalent thereof; and
(b) they do not exceed the amount used for or made available as an allowance determined by such school, institution, program, or other grantor, for—
(i) tuition,
(ii) mandatory fees (including the rental or purchase of any equipment, materials, and supplies related to the pursuit of the course of study involved),
(iii) books,
(iv) supplies,
(v) transportation,
(vi) origination fees and insurance premiums related to loans, and
(vii) other miscellaneous personal, and dependent care of the student incidental to attending such school, institution, or program.
Expenses specified as "room and board" are not allowable offsets to student income.
Financial assistance actually expended by the student for an allowable expense, or made available for attendance costs is excluded as income and resources. The institution or grantor may indicate that the assistance is meant to be used for allowable costs of attendance. Budget sheets and the like developed by the institutions or grantors shall be used as the verification of the amount of assistance and the attendance costs for which it is intended. If the institution does not indicate attendance costs or if the amounts indicated by the institution are less than the student claims to be using, students may provide verification of actual expenses for the exclusion of these amounts. If the student claims to be incurring higher transportation costs than the amount of transportation costs indicated by the institution, actual verified costs or the standard mileage allowance may be used. The MSEA rate found at https://www.maine.gov/osc/travel/mileage-other-info is the amount to be used if the standard mileage allowance is claimed.
(c) A loan in which repayment must begin within 60 days after receipt of the loan is not considered a deferred payment loan.
(4) Treatment of Work-Study Income
(a) Most work-study income is fully excludable under the Higher Education Act of 1965 (20 U.S.C. §1087uu).
(b) Treatment of work-study grants not funded by the excluded sources mentioned earlier in this section.
(i) Only that income actually realized by the student shall be considered. It may be less than the amount offered by the institution’s financial aid unit.
(ii) The realized income shall be reduced by the disregards detailed in 2 above.
(iii) The remaining amount if any, shall be reduced by the earned income deduction. (See Section 555-5.)
NOTE: The procedures outlined above regarding work study income also apply to other educational assistance which have a work requirement.
F. Income and expense averaging
(1) Student aid income and associated expenses are averaged over the period the educational institution indicates they are to be applied. The total figure is divided by the total number of calendar months indicated. No adjustment is made for partial months of enrollment.
(2) If the educational institution does not specify the months associated with a given income or expense they shall be attributed as follows:
(a) Amounts not attributed to a particular semester or term shall be applied to and averaged over the 9 month period from September through May.
(b) Amounts attributed to the fall semester shall be applied to and averaged over the 4 month period from September through December.
(c) Amounts attributed to the spring semester shall be applied to and averaged over the 5 month period from January through May.
(d) Amounts attributed to the summer term shall be applied to and averaged over the 3 month period from June through August.
(3) If receipt of student income cannot be reasonably anticipated in the first month indicated in (1) or (2) above, the period of application and averaging is adjusted to begin the first month receipt can reasonably be anticipated. This adjustment shortens the period and reduces the number of months over which the income is averaged. The end month is not adjusted.
Households in which all members receive SSI will be considered categorically eligible for SNAP. Do not include as members: ineligible noncitizens, ineligible students or residents of nonexempt institutions.
Subject to the “EXCEPTIONS” set out in Subparagraph C, below, all households are categorically eligible for SNAP if their gross income is at or below the limit detailed in Section 999-3 Chart 4 and at least one member of the household receives a TANF funded service or benefit.
The Maine Department of Health and Human Services Resource Guide for Families (Resource Guide) is a TANF funded service distributed to applicants at or below the limit detailed in Section 999-3 Chart 4. It includes general information about employment, nutrition, housing, utilities, child care, legal and other supports in Maine.
A. Narrow Categorical Eligibility
All households, with gross income at or below the limit detailed in Section 999-3 Chart 4, that have a child under the age of 18, or 18 and a full time high school student, who lives with a parent or caretaker relative are eligible for the Resource Guide.
B. Broad-Based Categorical Eligibility
All households with gross income that is at or below the limit detailed in Section 999-3 Chart 4 that do not include a child under the age of 18, or 18 and a full time high school student, are eligible for the Resource Guide.
C. EXCEPTIONS:
The households described in Subparagraphs A and B, above, are not categorically eligible for SNAP if:
(1) the entire household is institutionalized in a nonexempt facility,
(2) a member of the household is presently disqualified for an Intentional Program Violation,
(3) the household fails to complete annual eligibility review requirements, or
(4) the head of household fails to comply with work requirements, including job quit (Section 111-6.
A. The factors listed below are considered to be met for categorically eligible households.
(1) asset limits;
(2) transfer of assets;
(3) Social Security Number requirements;
(4) sponsored noncitizen requirements; and
(5) residency and identification requirements;
(6) 130% gross and 100% net Federal Poverty Level income limits. (See Section 999-3 Charts 1 and 2.)
B. Even though these households are considered to be categorically eligible for SNAP benefits, all individuals who are not SSI or GA benefit recipients must have the following factors verified:
(1) Social Security Number requirements,
(2) sponsored noncitizen requirements, and
(3) residency and identification requirements.
Households in which all members receive General Assistance are pure GA households. Pure GA households are eligible for SNAP benefits. Ineligible noncitizens, ineligible students, residents of nonexempt institutions, individuals disqualified for failure to provide or apply for a social security number, household members disqualified for failure to comply with work requirements, and individuals disqualified for Intentional Program Violations are not counted as household members.
A. EXCEPTION:
The GA Household is not categorically eligible if:
(1) a member of the household refuses to cooperate in providing information to OFI that is necessary to determine eligibility or to complete any subsequent review of eligibility;
(2) the household is ineligible under the striker provision in Section 444-9; or
(3) the household is ineligible because they knowingly transferred assets for the purpose of qualifying or attempting to qualify for SNAP benefits.
B. Factors considered to be met for pure GA households
The factors listed below are considered to be met for pure GA households.
(1) assets limits;
(2) 130% gross and 100% net Federal Poverty Level income limits;
(3) sponsored noncitizen requirements; and
(4) residency and identification requirements.
Applicants may apply for TANF/PaS and SNAP at the same time. SSI applicants may apply for SNAP at the Social Security Office (Section 222-1) or at the Department of Health and Human Services. GA applicants can get an application at the GA office but must apply for SNAP through the Department of Health and Human Services.
If TANF or PaS/SSI/GA eligibility has not been determined, SNAP eligibility is based upon SNAP criteria. Denial of a potential categorically eligible household will be delayed for thirty days from the SNAP application date. Households denied SNAP benefits that have a pending SSI or GA application shall be notified of the possibility of categorical eligibility should they become SSI or GA recipients.
If SNAP was denied prior to the granting of TANF or PaS/SSI/GA, SNAP benefits for the initial month must be prorated from the date from which the TANF or PaS, SSI, or GA benefits are payable, or the date of the original SNAP application date, whichever is later.
One and two member categorically eligible households shall receive at least the minimum benefit found in Section 999-3 Chart 6, regardless of the amount of net income.
Households with three or more members who are eligible for zero benefits are not denied. They are suspended. Such households are “authorized to receive benefits.”
A. Individuals are considered recipients of SSI or GA even if not receiving payments due to:
(1) benefits have been authorized but payment has not yet been received;
(2) benefits are suspended or recouped; or
(3) the benefit amount is less than minimum benefit paid.
B. Households are categorically eligible due to TANF or PaS authorization even if not receiving payments because:
(1) benefits have been authorized but payment has not yet been received;
(2) benefits are suspended or recouped;
(3) the benefit entitled to is less than minimum benefit paid; or
(4) benefits or services are authorized but not used.
A. Categorical eligibility related to TANF or PaS continues until the benefit or service is no longer funded by TANF funds.
B. Categorically eligible households must be automatically terminated from SNAP for failure to become timely re-certified, even though they continue to receive TANF or PaS, SSI, GA or a TANF funded service or benefit.
C. Categorically eligible individuals are subject to annual eligibility review (Section 666-9), and work registration and employment/training requirements and exemption criteria (Section 111-5). Job quit penalties (Section 111-6) also apply.
GENERAL RULE - A household with a striking member is ineligible, unless it was eligible on the day prior to the strike. Households receiving benefits on the day prior to the strike cannot receive an increase in benefits due to the decreased income of a striking member.
Pre-strike income is determined by comparing the striker's income prior to the strike to his current income, and then adding whichever is more to the rest of the household's current income. The earnings deduction is allowable.
NOTE: Vehicles normally exempt from equity consideration retain the exempt status during the strike.
Striking members of eligible households are subject to work requirements. Those members who are exempt from work registration are not considered strikers.
A striker is anyone involved in a strike or concerted stoppage, slowdown, or interruption of work by employees.
Some examples of non-strikers are:
1. Employees unable to work as a result of other employees striking;
2. employees whose place of employment is closed by an employer;
3. employees who are not part of the unit on strike, but do not want to cross a picket line due to fear of injury or death.
In all cases of a strike where permanent replacements have been hired by the company, the persons whose jobs are replaced, are no longer considered strikers. They must be able to return to the same job they left when the strike began to be considered a strike.
A. Disqualifications are based on the policy that was in place at the time of the infraction.
(1) As of December 30, 2021 an individual disqualified for Intentional Program Violation (IPV) of another means-tested federal, state, or local welfare public assistance program (such as but not limited to TANF, SSI, GA, FDPIR – see Section 999-1 page 3 for additional information) is not eligible for SNAP. Individuals who have only been sanctioned or disqualified from MaineCare (Medicaid) are not automatically disqualified from SNAP.
(2) Infractions committed prior to December 30, 2021 that would result in a disqualification from SNAP based on the policy in place at that time will continue to result in disqualification even if the disqualification begins after or continues beyond December 30, 2021 or the infraction was not substantiated or even discovered until after December 30, 2021.
B. In order to be disqualified from SNAP due to a disqualification from another program, the individual must be receiving SNAP at the time of the sanction.
NOTE: If the other program disqualifies the entire household because of one household member's IPV, only the individual who caused the IPV is disqualified from participation in SNAP.
The disqualification period shall continue until the program which imposed the disqualification no longer considers the individual disqualified. If an individual was disqualified for an unlimited period (e.g., “until complies”), and the household is no longer participating in that program, the disqualified individual will no longer be considered disqualified from SNAP starting the first day of the second month after benefits from the other program ceased (e.g., if the other program’s last benefit was issued in December, SNAP participation may resume February 1).
An individual who has been disqualified from FDPIR for an IPV is not allowed to participate in SNAP until the disqualification period has expired.
1. General Rule
Households may contain some individuals who are eligible for federally-funded SNAP and some who are only eligible for state-funded SNAP.
2. Attribution of Assets, Income and Expenses
A. Income is counted for the individual in whose name it is received.
EXCEPTION: TANF income is prorated for all household members receiving TANF benefits.
B. Shelter expenses for the household are counted for the individual in whose name the expense is billed.
NOTE: If the bill is paid by another household member on a regular basis, the expenses will be attributed to the member paying the bill.
3. Determining the state funded benefit amount
State-funded SNAP benefits are equal to the difference between the federally-funded SNAP grant and the amount of SNAP benefits the household would have received had all members been eligible.
Gross Lottery or gambling winnings, by any individual(s) in a single game, equal to or in excess of the figure found in Section 999-3 Chart 9 for Non-Categorical Households with an Aged or Disabled Member, shall disqualify the household from benefits until they reapply and financial eligibility guidelines set forth in Sections 333, 444 and 555 are met. When winnings are shared by household members and non-household members, a prorated share will be counted for the household. That share is determined by dividing the total countable winnings by the total number of winners and multiplying that figure by the number of winners who are household members.
For purposes of determining eligibility and benefit level the income already received during the certification period and any income which can be reasonably anticipated during the remainder of the certification period is taken into account. If the amount of income anticipated or month of receipt is uncertain, that portion of the household’s income which is uncertain is not counted. For example, a household anticipating income from a new source, such as a new job or pending TANF benefits, may not be sure of the timing or amount of the first payment. Such income is not anticipated unless there is reasonable certainly concerning the month in which it will be received and what the amount will be. When the exact amount is not known, only that portion of it which can be anticipated with reasonable certainty is considered as income.
NOTE: For households with members who are funded by Federal and State funds, see Section 444-11.
The best estimate of income is based on the recipient’s and the Department’s reasonable expectations and knowledge of current, past and future circumstances. The best estimate of income, is based on the concepts of significant and non-significant income changes and the income averaging techniques described below. The method of determining the best estimate of income must be clearly documented in the case record.
A. Significant income changes are defined as changes in sources of income or in amounts greater than $125 per month which are:
(1) expected to continue into the future; or
(2) short term, but will continue long enough to affect at least one allotment.
B. Some examples of significant income changes include starting a job, gaining a new source of unearned income, losing a job or unearned income, changes in the rate of return on investments that are expected to persist, permanent or long term changes in hours worked and/or rate of pay, permanent full-time employment, beginning to work piece-work or overtime, promotion, changing employers, short term plant closings or periods of absence without compensation, and other similar changes.
C. The Department shall use information about past significant changes of a continuous nature in estimating future income. For example, if an individual received an increase in the hourly wage in the recent past, the wages received prior to the pay raise are not used in determining the best estimate of future income. An average of the hours worked per week multiplied by the new hourly wage must be used in determining the estimate.
A. Non-significant income changes are defined as temporary, very short term variations in the earned or unearned income amount caused by a situation which is not of an ongoing nature or which is of a variable nature.
B. Some examples are changes in the rate of return on investments that are not expected to persist, previously anticipated fluctuations in wages, occasional changes in wages due to unpredictable overtime, unpaid absences, or occasional illness.
C. When non-significant income changes occur during the certification period, they often do not impact eligibility or benefits.
D. Unless the income is averaged, it is counted as income only in the month it is received. Whenever a full month's income is anticipated but is to be received on a weekly or biweekly basis, it is converted to a monthly amount by multiplying weekly amounts by 4.3 and biweekly amounts by 2.15. When less than a full month's income is anticipated, the actual amount of anticipated monthly income is used.
E. With the exception of migrant farm worker households which are destitute, households may elect to have income averaged. Households which, by contract or self-employment derive their annual income in a period of time shorter than a year have that income determined in accordance with Section 444-2.
F. Households receiving scholarships, deferred loans, or other educational grants have such income averaged over the period for which it was provided. (See Section 444-7(2).)
G. Nonrecurring lump sum payments are counted as assets starting in the month they are received. They are not counted as income in determining SNAP eligibility and benefits amounts.
H. Annuities and lottery winnings that are paid annually are averaged over a 12 month period.
I. Wages held at the request of the employee are considered income in the months they would otherwise have been paid. Wages held by an employer as a general practice are not counted until they are expected to be received. Advances on wages are counted when reasonably anticipated.
J. Households receiving income on a recurring monthly or semimonthly basis do not have their countable monthly income varied merely because of changes in mailing cycles or pay dates or because weekends or holidays cause additional payments to be received in a month.
The steps below are followed to determine the best estimate of income.
A. All earned and unearned income received within a minimum time frame of four weeks immediately preceding the application or review must be verified even if not all four weeks’ income is used to calculate the best estimate.
If not all pay stubs for the four week period are available, but the gross income can be verified for each pay interval through year-to-date information, the four week period’s income is deemed to be verified.
B. The Department shall determine, through a careful review of the income documentation and discussion with the individual, if there have been any significant income changes during the four week period. If there have been, and the changes are of a continuous nature, the changes must be taken into consideration when determining the best estimate. For example, if an individual has received an increase in hourly rate, the new hourly rate must be multiplied by the appropriate number of hours (either stable or averaged) to determine the anticipated income.
C. The Department shall determine if any significant income changes are expected in the future. If yes, and the exact nature of the significant income change is known, the Department shall use that information in determining the best estimate of income.
D. The Department shall determine, through careful review of the documentation, the case record, and discussion with the individual if any of the income received is not expected to be representative of the future. For instance, the first pay check of new employment may not represent a full pay period, or a missing week's income may represent a summer plant closing which is not anticipated to occur in the next certification period. Non-representative income (or lack of income) is not used in calculating the best estimate. The case record must be clearly documented to explain why any income was not used, and to show how the best estimate was figured.
E. If income fluctuates to the extent that a four week period is not expected to provide the best estimate of income for the future review period, the Department may use information covering a longer period of time. If the income is from self-employment the Department may use the most recent tax year’s income.
F. The final step is to average the income representative for the eligibility period. If there were significant income changes, averaging is used only for the period of time not affected by the significant change-e.g., if the rate of pay increased, only the hours worked are averaged. The average hours multiplied by the increased rate of pay is then used to determine eligibility and benefits for the one time and prospective periods.
NOTE: If income does not fluctuate it is not necessary to average the income.
GENERAL RULE - Count all earned income from any source, excluding only those items listed under Exempt Income (FS 555-4).
1. Wages and Salaries - Include payments such as: gross earned income (before any payroll deductions), garnished wages, tips, commissions, etc. Workfare assistance payments are considered unearned income.
2. Self-Employment - Income derived from any self-employment activity (FS 444-2).
Types of self-employment may include:
a. Independent contractors, franchise holders, owners/operators, farmers, people who produce and sell a product, and service-type businesses;
b. seasonal self-employment such as fishing, clamming, worm digging, logging, etc.;
c. income from boarders (FS444-3);
d. income from roomers (FS 444-2);
e. ownership of rental property if a household member is actively engaged in the management of the property on an average of at least twenty hours per week. See FS 555-3 for those households not actively engaged in property management.
3. Training Allowances - That portion of training allowances which exceeds expenses, and represents a gain or benefit to the household.
4. W.I.A. - On the job training WIA earnings of household members except for dependents less than 19 years old and, regardless of age, except for participants in the Summer Youth Employment and Training Program and comparable summer youth employment and training programs under Americorps.
NOTE: Americorps does not provide OJT.
5. Attendant Care Payments - Attendant care payments provided by an outside source if the person providing the care is a household member.
NOTE: see FS 555-3, #9 for treatment of similar income as unearned income and FS 555-4, #7 for treatment of similar income as excluded income.
ACCEPTABLE VERIFICATION (Not all Inclusive):
- Pay stubs (if complete)
- Pay envelopes (if complete)
- W-2 Form
- State or Federal Income Tax Return
- Self-employment bookkeeping records
- Sales and expenditure records
- Employer's statement (signed and dated by employer)
- Employer's wage record
- Employment Security Office records
HOUSEHOLDS HAVE THE PRIMARY RESPONSIBILITY TO PROVIDE VERIFICATION OF EARNED INCOME - If necessary, the agency will assist the household in securing the required verification.
Countable unearned income includes, but is not limited to:
A. Assistance Programs -
The full amount of payments from Supplemental Security Income (SSI), Temporary Assistance for Needy Families (TANF), Parents as Scholars (PaS), or other means-tested assistance
(1) TANF or PaS payments which are diverted to a third party are counted as income. See Section 555-4 for certain exclusions.
(2) Assistance payments from programs which require the performance of work without compensation other than the assistance payment are considered unearned income.
(3) If a payment from SSI, TANF, PaS, General Assistance (GA), or other means-tested assistance is reduced or ended due to the sanctioning or disqualification of a household member due to non-compliance with the program’s requirements, the full benefit (as if the individual was not sanctioned or disqualified) will be budgeted as unearned income. This amount will continue to be budgeted—
(a) for the duration of the disqualification if the household continues to receive the benefits from the sanctioning or disqualifying program, or
(b) through the end of the month the household ceases to receive benefits from the sanctioning or disqualifying program if the sanction or disqualification is open ended (e.g. until the individual complies) (e.g., if the other program’s last benefit is issued in December, no amount of that benefit is budgeted for January.).
B. Other Payments such as, but not limited to: Pensions, annuities, retirement, disability or veteran's benefits, unemployment insurance, workers’ compensation, social security, dividends, interest, royalties, income from installment contracts (both principal and interest), strike benefits, and payments from government programs not specifically excluded by law.
C. Trust Funds - Money received from a trust.
D. Rental Income - Gross income, less the cost of doing business (Section 444-2).
EXCEPTION: If any household member is actively engaged in management of the property on an average of at least 20 hours per week, consider as earned income (Section 555-2).
E. Child Support or Alimony - Payments made directly to the household, including the pass through and gap supplements. This includes money deducted or diverted from court ordered support or alimony to pay household expenses.
F. Income from Sponsors of Noncitizens - See Section 444-1.
G. Students with Educational Income - portion of loans, grants, scholarships and other educational benefits not excluded (Section 444-7(2)).
H. Money that is legally due the household which is diverted to a third party to pay household expenses.
EXAMPLES:
(1) Diversion of all or part of a TANF or PaS benefit to a lessor;
(2) that portion of an Unemployment Insurance Benefit (UIB) check intercepted by the Division of Support Enforcement and Recovery (DSER);
NOTE: GA vendor payments are excluded. See Section 555-4(2)(C).
I. Money that is legally due a household member but is received and used for that household member by a non-household member.
J. Income from investments or trading including but not limited to currency trading (including crypto currency), day trading, and dividends on long term investments.
A. Documentary evidence is the primary source of verification. Whenever attempts to verify income have failed for reasons other than applicant or participant non-cooperation, an amount to be used shall be determined based on the best available information. If verification (other than documentary evidence) is used, the reason why shall be recorded in the case file.
B. The following documents are generally available to verify unearned income:
(1) All types of award letters
(2) Income tax records
(3) Support and alimony payments evidenced by court order, divorce or separation papers, or check copies.
(4) BENDEX and SDX
(5) Social Security Wire to Wire Third Party Query
(6) Social Security District Office records
(7) Maine Employment Security Commission
(8) Worker's Compensation records
(9) Insurance company records
(10) GA Agency records
(11) Social Service Agencies’ records
All income is counted with the exception of income under the following categories:
1. Loans - All loans, except loans on which repayment is deferred until completion of that member's education. (A statement signed by both parties indicating the money is a loan is acceptable verification.) For treatment of student loans see Section 444-7(2). For repayment of home equity loans see allowable shelter costs, Section 555-5(7)(A)(1).
2. Certain Vendor Payments
A. Money payments by a non-household member which are not legally due the household and are paid directly to a third party for a household's expense. For example, a relative pays the rent or an employer pays the rent and it is not considered part of the individual’s compensation by the employer.
B. TANF vendor payments made to a third party which are not normally included in the TANF benefit or which are over and above the normal TANF payment (currently, Maine does not restrict any part of TANF assistance to a vendor payment; therefore, this exclusion does not apply to TANF in Maine).
C. Vendored assistance from state or local programs which provide no cash assistance. This includes General Assistance vendor payments made to a third party. All General Assistance payments must be made in the form of a third party vendor payment, and are excluded under provisions of the Food and Nutrition Act.
D. Court ordered vendor payments in lieu of a direct payment.
3. Income in Kind - Any gain or benefit which is not money such as shelter provided by an employer not considered part of the individual’s compensation by the employer or a lessor, produce from a garden, clothing, gift cards, etc.
4. Repayments - Monies withheld or returned from an assistance payment, earnings, or other source to repay a prior overpayment from that source.
EXCEPTION: The gross amount is counted when the overpayment is the result of an intentional violation of program rules in a means-tested program, such as TANF/PaS or SSI. An intentional program violation in TANF/PaS must be determined by a court or an administrative hearing or the signing of a waiver.
5. Child Support Payments - Received by TANF/PaS recipients that are turned over to the Department of Health and Human Services.
NOTE: See Paragraph 20 of this section for treatment of child support payments made by SNAP recipients.
6. Excluded Reimbursements and Allowances
A. Payments which do not exceed the actual costs for job-related or training-related expenses, medical expenses, or dependent care expenses. This includes allowances from SNAP E&T and WIOA.
NOTE: No ASPIRE or HOPE work related expense payments are counted, even when received prospectively.
B. Compensation and reimbursements, for participation in committees, councils, and advisory boards that are related to health and human service programs. These groups may be established by the legislature, state agencies, or local non-profit organizations. Compensation and reimbursement includes stipends, legislative per diem, travel reimbursement, and other similar payments.
7. Third-Party Payments - Monies both received for and used for the care of a third-party beneficiary who is not a household member.
NOTE: When payments are made to both household and non-household members, any portion of the payment intended and used for the care and maintenance of the non-household member is excluded. If the non-household member's portion cannot be identified, the payment is prorated among intended beneficiaries. The greater of the household member's prorated share or the amount actually used for the household member's care and maintenance, is counted.
8. Earned income of an elementary or secondary school student 17 years of age or younger who lives with their natural, adoptive, or stepparent, or who is living under the parental control of a household member other than a parent.
An elementary or secondary school student is someone who attends elementary or secondary school enough time for that person’s state or local school district to consider the person a “student”. This includes a student who attends high school equivalency or home-school classes recognized, operated, or supervised by the student’s state or local school district.
The treatment of this income will not be altered by semester breaks, summer vacations, etc., provided the student will resume enrollment after the break (Section 444-7).
NOTES: The student’s income is excluded until the month following the month in which the student turns 18. If the household receives one payment for work performed by all members and the student's portion is not defined, the income is divided equally among the number of household members working and the portion allotted to the student is excluded.
9. Losses from Farming Enterprise (Section 444-2)
10. Nonrecurring Lump-Sum Payments
Some examples are: Income tax refunds, including the Earned Income Tax Credit (EITC), Alternative Aid and Emergency Assistance payments. That portion of retroactive lump-sum Social Security, Supplemental Security Income (SSI), railroad retirement or insurance settlements intended to cover a period prior to the budget month. See Section 333-2 for if and when these payments would be countable assets.
NOTE: That portion of a Temporary Assistance for Needy Families (TANF) or Parents as Scholars (PaS) retroactive payment which covers a period prior to the payment month is treated as an asset, rather than income. The same is true of a nonrecurring Division of Support Enforcement and Recovery (DSER) pass through and gap payment for a prior period.
11. Specified Student Income Exclusions - See Section 444-7(2).
12. Certain cash donations, based on need, from one or more private, nonprofit charitable organizations. The first $300 of such cash donations per federal fiscal year quarter are excluded.
NOTE: FFY Quarters are as follows: October – December, January - March., April - June, and July – September.
13. Income excluded by Federal statute including but not limited to:
A. Energy Assistance - Payments or allowances made to households with at least one member who is elderly or has a disabling condition under any federal energy assistance law except those provided under Title IV(A) of the Social Security Act. Department of Housing and Urban Development (HUD) utility payments and reimbursements are considered federal energy assistance.
NOTE: If a household incurs utility expenses in excess of the HUD utility payments or reimbursement, they are eligible for the appropriate utility standard (see Section 555-5).
NOTE: An expense paid on behalf of the household under state law to provide energy assistance is considered an out of pocket expense incurred and paid by the household.
B. Workforce Investment and Opportunity Act (WIOA) payments
EXCEPTION: Payments from WIOA’s on-the-job training program (OJT) are counted unless
(1) they are received by dependents less than 19 years old or,
(2) they are received by participants (regardless of age) in the Summer Youth Employment and Training Program or comparable summer youth employment and training programs under Americorps. Americorps does not provide OJT.
Americorps Volunteers in Service to America (VISTA) - These payments are excluded only if the recipient was receiving SNAP or public assistance at the time they enrolled in VISTA. Temporary interruptions in SNAP participation do not change the exclusion once an initial determination of exemption has been made. Applicants not receiving public assistance or SNAP when they joined VISTA will have VISTA payments counted as earned income.
EXCEPTION: VISTA volunteers who were receiving FS prior to January 1, l979, continue to have VISTA income excluded.
D. Americorps (State or National) stipends
E. National Older Americans Volunteer Programs including but not limited to-
(1) Retired Senior Volunteer Program (RSVP)
(2) Foster Grandparent Program
(3) Older American Community Service Programs
(4) Senior Health Aides and Senior Companions
(5) Service Corps of Retired Executives (SCORE)
(6) Active Corps of Executives (ACE)
F. Payments Under the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970.
G. Women, Infants and Children (WIC) Program
H. Special Native American Payments - Excluded by law, such as payments under the Maine Indian Land Claims Settlement Act.
I. Wages under the Senior Community Service Employment Program (SCSEP) of the Older Americans Act.
J. Payments made from the Agent Orange Settlement Fund or any other fund established pursuant to the settlement in the Agent Orange product liability litigation.
K. Federal Earned Income Tax Credit (EITC) whether received as advanced payment in weekly wages or received in one lump sum after filing annual income tax return.
L. Interest and matching investments in Achieving a Better Life Experience (ABLE) accounts, established under Sec. 529A of the Internal Revenue Code of 1986.
14. Amounts necessary for the fulfillment of a plan to achieve self-support (PASS) excluded by the Social Security Administration in figuring SSI payments.
15. State or federal one-time assistance for weatherization or emergency repair or replacement of an unsafe inoperative or other heating or cooling device made to households with at least one member who is elderly or has a disabling condition.
16. Matching awards of Savings Offer Success (SOS) made by Rural Opportunities, Inc. (ROI) to households that participate in their program.
17. Funds in the Department of Housing and Urban Developments (HUD) Family Self-Sufficiency Program (FSS) escrow accounts.
18. Nutritional Assistance Program (NAP) Benefits from Puerto Rico, American Samoa and the Commonwealth of the Northern Marianas.
19. Payments to a former spouse made under the Uniformed Services Former Spouses' Protection Act. These are part of a property settlement involving military retirement.
20. Legally obligated child support payments
Household income used to make legally obligated child support payments from a household member to or for an individual who is not a member of the household is excluded.
NOTE: The exclusion is allowed when a child support payment is made to an individual or an agency outside the household even if the child for whom the support is paid is a household member. However, child support paid by a household member which is received by a member of that household will not be allowed as a child support exclusion or counted as child support income (e.g., child support arrearage that is paid to the state by a household member and is forwarded by the state to a child entitled to the support payment who resides in that household is counted as income of the payer of the child support, not the child).
A. Household income used to make the following legally obligated child support payments are excluded:
(1) payments made for current obligation.
(2) payments made for unmet past obligation. or
(3) in-kind payments if the in-kind nature of the payment is ordered by the court or administrative child support hearing (ex. The court ordered the individual to pay for a child’s health insurance)
B. Households must verify child support payments that they are legally obligated before the income used to make them is excluded. Copies of legal procedures, canceled checks, signed statements from payee, and information from the Division of Support Enforcement and Recovery (DSER) are sufficient.
C. Household income used to make:
(1) child support payments which are not legally obligated (e.g. Voluntary payments),
(2) child support payments which divert from the court order (e.g. Purchasing clothing instead of paying the $50/wk. ordered by the court),
(3) spousal or any other non-child support payments, or
(4) child support collected through tax intercept
is counted.
21. Monies received as accrued interest on a recipient’s Family Development Account or Separate Identifiable Account;
22. Monies received as a match on deposits a recipient makes in their Family Development Account or Separate Identifiable Account set up as authorized by state law 20-A M.R.S. § 10982 up to the $10,000 cap; or
23. Any additional money from military personnel during the time of deployment to a combat zone that is made available to the SNAP household.
24. Training and Education related stipends when they are means tested, intended to help the assistance unit meet their basic needs, and all of the funding is from non-governmental sources.
Certain expenses are deducted from countable income. These expenses must be incurred by the household. They are only deductible if the service is provided by someone outside the household. Deductible expenses are determined prospectively. Only the deductions listed in this section are allowed.
20% of total gross earnings is deducted to allow for work related expenses such as taxes, retirement deductions, and transportation.
Exceptions: the earned income deduction is not allowed for that portion of earned income:
A. earned under a work supplementation or support program that is attributable to public assistance; or,
B. which the household failed to report in a timely manner (when determining an over issuance).
NOTE: Workfare assistance payments are considered unearned income and not subject to this deduction.
The standard deduction varies according to household size and is adjusted annually for cost-of-living increases. They can be found in Section 999-3 Chart 7.
Certain medical expenses incurred by individuals who are elderly or have disabilities (Section 999-1) may be deducted.
A. The following expenses are not deducted:
(1) the cost of items that can be purchased with SNAP benefits even if they are for a special diet;
(2) reimbursable medical expenses even if they are listed in B below, (E.g. an individual may pay out of pocket for eyeglasses but that portion which will be reimbursed by their health plan or employer is not an allowable deduction for SNAP.);
(3) the cost of anything that violates federal law;
(4) interest or penalties associated with a payment plan or delayed payment; or
(5) the first $35.00 of allowable medical deductions per month per household.
B. To the extent that they are allowable under A above, the following verified medical costs may be deducted:
(1) dental and medical care, and psychotherapy and rehabilitation services by qualified health professionals;
(2) hospitalization, outpatient treatment, nursing care and nursing home care (including payments for persons who were household members immediately prior to entering a hospital or nursing home) recognized by the State;
(3) prescription drugs when prescribed by a licensed practitioner; over the counter medication (including insulin) when approved by a licensed practitioner or other qualified health professional; and medical supplies, sick room equipment (including rented), or other prescribed equipment;
(4) Medicare premiums and health and hospitalization insurance policy premiums;
EXCEPTION: Health and accident policies (such as those payable in lump-sum settlements for death or dismemberment) are not allowed.
(5) dentures, hearing aids, and prosthetics;
(6) food and veterinarian bills for a guide dog or any service animal specifically trained to serve the needs of an individual who is elderly or has disabilities;
(7) prescription eyeglasses;
(8) costs of transportation and lodging necessary for the individual to obtain medical treatment including the costs for an attendant when necessary.
NOTE: For transportation costs, actual verified costs or the MSEA mileage allowance found at https://www.maine.gov/osc/travel/mileage-other-info may be used.
(9) Costs of attendant, homemaker, home health aide, child care services or housekeeper necessary because of age, infirmity or illness including an amount equal to the one-person Thrifty Food Plan (Section 999-3 Chart 5) if the household provides the majority of the attendant's meals. If the attendant care costs qualify under both medical and dependent care deduction, it is applied as a dependent care deduction.
C. Household must verify medical expenses before they are budgeted. Copies of paid or unpaid bills are sufficient.
When supervision of a qualified dependent is necessary for an individual to engage in a qualified activity (See Subparagraph B below) and is not provided by a household member, those costs are deductible.
A. Qualified Dependents are either:
(1) children under the age of 18, or
(2) individuals of any age who are incapacitated and unable to participate in normal activities (including but not limited to work or school) who are at risk for health and safety issues without supervision. If the attendant care costs qualify under both medical and dependent care deduction, it is applied as a dependent care deduction.
B. Qualified activities are:
(1) working,
(2) seeking employment, and
(3) attending training or schooling in preparation for employment.
C. Household must verify dependent care expenses at application and annual eligibility review before they are budgeted. Copies of paid or unpaid bills, or statement from provider are sufficient.
Households experiencing homelessness who incur or reasonably expect to incur shelter costs during a month are eligible for the Homeless Shelter Deduction found in Section 999-3 Chart 8.
Note: This is a deduction and not a shelter expense.
Shelter costs over 50% of the household's income after all other deductions are deducted, up to the maximum excess shelter deduction found in Section 999-3 Chart 8.
EXCEPTION: No maximum shelter cap applies to households with one or more members who are elderly or have disabilities (Section 999-1).
NOTE: For households with members who are non-citizens funded by a mix of Federal and State funds see Section 444-11.
A. Allowable shelter costs are—
(1) continuing charges leading to ownership of or required for continued occupancy of the shelter occupied by the household (e.g. rent, mortgage (including second mortgages), condominium fees, and required association fees);
NOTE: Security deposits are not budgeted.
(2) property taxes, state and local assessments, and insurance on the structure;
NOTE: Separate costs for insuring furniture or personal belongings are not budgeted.
(3) electricity, gas, heating/cooling costs, cooking fuel, water, sewer, trash collection, basic fee (and tax on basic fee) for one telephone and initial installation of utilities (These utilities are budgeted per Paragraph B below.); and
(4) charges for repair of the home when damaged by natural disaster, unless reimbursed by private or public relief agencies, insurance, etc.
B. UTILITY EXPENSES
Households eligible for the Full Standard Utility Allowance (FSUA), Non-Heat Utility Allowance (NHUA), or Phone Only Utility Allowance (PhUA) have it used as the utilities portion of their shelter expenses. Households not eligible for any utility allowance have the actual verified expense used as the utilities portion of their shelter expenses.
For households using part or all of their utility expenses as self-employment expenses, see C below.
For treatment of utility expenses for a home temporarily vacated, see D below.
All Utility allowance amounts can be found in Section 999-3 Chart 8.
(1) FSUA
(a) A household who has received more than $20.00 in Low Income Heating Assistance Program (LiHEAP) benefits or similar energy assistance benefits in the period including the current month and the immediately preceding 12 months is eligible for the FSUA if at least one household member is elderly or has a disabling condition.
(b) A household who incurs, in full or in part, heating or air conditioning expenses apart from their rent or mortgage bill even if on an irregular basis is eligible for the FSUA. When someone outside the household is paying the entire cost of heating/cooling, and the payment is excluded as a vendor payment, the household is not eligible for the FSUA.
(c) Households living in a housing unit which has central utility meters and are charged only for excess utility costs are eligible for the FSUA.
(2) NHUA
A household who incurs at least two of the following expenses: cooking, lights, water, sewer, telephone, or trash collection including the costs of trash bags, land fill fees, etc. is eligible for the NHUA.
If a household has only one of the above expenses, they are not eligible for the NHUA. If the one expense is not telephone, actual expense must be used.
If multiple households share utility expenses, each household eligible for the NHUA receives the full NHUA.
(3) PhUA
Households not eligible for the FSUA or the NHUA who incur telephone expenses including basic line charges, cellular phone fees, or telephone cards are eligible for the PhUA.
If multiple households share telephone expenses, each household eligible for the PhUA receives the full PhUA.
C. USE OF RESIDENCE FOR SELF EMPLOYMENT
That portion of the shelter costs budgeted as self-employment expenses (Section 444-2) cannot be used as shelter expenses. Households are still eligible for the appropriate Standard Utility Allowance based on utilities not paid in full by the business.
D. HOME TEMPORARILY VACATED
Shelter costs for a home temporarily vacated by the household because of employment or training, illness, natural disaster or casualty loss are deductible only if:
(1) the household intends to return,
(2) the current occupants are not claiming shelter costs for SNAP purposes, and
(3) the home is not leased or rented while household members are absent.
NOTE: Households are only eligible for one utility allowance based on all shelter utilities.
A. Except when expenses are averaged, a deduction is allowed only in the month the expense is billed or otherwise becomes due, regardless of when the household plans to pay the expense. For example, rent which is due each month shall be counted even if the expense is not yet paid. Amounts from past billing periods are not deductible.
NOTE: When a household occupies a residence that has a monthly rent structure, the monthly amount of rent should be budgeted for each month when the shelter deduction is determined, without regard to when the rent was actually paid. For example: A SNAP household with a monthly rent of $500.00 received a financial windfall in November and paid rent for the next six months. The $500.00 rental payment is counted for each of those pre-paid months.
B. Deductible expenses must be payable to someone outside the household.
C. Fluctuating expenses may be averaged.
(1) General Rule
Expenses which are billed less often than monthly may be averaged forward over the interval between scheduled billings or if there is no schedule over the period the expense is intended to cover.
(2) One-time only medical expenses are treated as a one-time only deduction (see A above), averaged over the certification period or remainder thereof, or in the instance of installment purchases over the life of the repayment schedule at the household’s option. Averaging begins the month the change would become effective. If the change cannot be reflected within the certification period the expense is verified, the Department shall issue a supplemental allotment.
D. That portion of the household's expense paid by an excluded vendor payment (Section 555-4(2)) is not budgeted. Expenses paid via a countable vendor payment (such as those paid by countable student aid (Section 444-7(2) or court ordered child support (Section 555-3(1)(E)) are budgeted.
E. The household's expenses are calculated based upon the expenses expected to be billed during the certification period. Anticipation of the expense is based upon the most recent month's bills unless it is reasonably certain that a change will occur. Changes may also be anticipated based on last year's bills for the same period updated to reflect overall price changes. The amount that can be budgeted cannot be determined solely by averaging past expenses, such as utility bills, for the last several months.
A. Gross Income:
The household's total countable gross income must be at or below the gross income standards (Section 999-3 Charts 2 - 4) to determine Categorical Eligibility, eligibility to be considered a separate household from an elderly individual or an individual with disabilities and/or eligibility for benefits. If the gross test is passed all other conditions must still be met.
B. Determining Net Income:
If the household may be eligible after the gross income tests, this step-by-step procedure is used to calculate the net monthly income:
(1) Add all gross earned and unearned income including legally obligated child support payments.
(2) Subtract 20% of earned income (Section 555-5).
(3) Subtract legally obligated child support payments.
(4) Subtract the Standard Deduction (Sections 555-5 and 999-3 Chart 7).
(5) If the household contains a member who is elderly or has a disability, subtract the Excess Medical Deduction (Section 555-5).
(6) Subtract dependent care expenses.
(7) If applicable, subtract homeless shelter deduction to determine adjusted net income (Sections 555-5 and 999-3 Chart 8).
(8) Subtract the Excess Shelter Deduction
(a) Determine total shelter costs (Section 555-5).
(b) Subtract half the figure arrived at in 7, above, from the shelter costs to determine the shelter deduction.
(c) Subtract the shelter deduction up to the cap (Section 999-3 Chart 8) from the adjusted net income to determine the net SNAP income (NSI) (Section 555-5).
EXCEPTION: There is no shelter cap for a household containing at least one individual who is elderly or has a disability.
If the NSI is less than $0, it is raised to $0.
C. Net Income Test:
Non-categorical households must have an NSI at or below the net income standard (Section 999-3 Chart 1).
A. Determining a Full Month’s Benefit
An eligible household’s monthly benefit is determined by subtracting 30% of the NSI from the Thrifty Food Plan for that size household (Section 999-3 Chart 5) and rounding down to the nearest whole dollar.
EXCEPTION: Except for the initial month, eligible one and two member households are eligible for a minimum allotment (Section 999-3 Chart 6).
B. Determining an Initial Month’s Benefit
The initial allotment is determined by the following:
(1) No minimum allotment is taken into consideration for the initial month.
(2) Migrant and seasonal farm worker households which participated in the program, in the previous month are eligible for a full month’s benefit for the initial month.
(3) For all other households the allotment issued for the initial month is prorated from the date of application (Section 999-1) or the date the household takes the required action per the standards established in Section 222-6(5).
(a) The corresponding figure in the “Table of Percentages for Proration” in Section 555-7 is multiplied by the full months benefit calculated in A, above (disregarding the minimum).
(b) The product is rounded down to the nearest whole dollar.
(c) If this figure is less than ten, there is no allotment for the initial month. Otherwise, this figure is the allotment for the initial month.
(4) The Department shall not reduce an initial month’s allotment to pay off a claim without the household’s permission.
(5) The allotment for the initial month after an annual eligibility review and any month there was a break in participation during the certification period is only prorated if the household was at fault for the break in participation.
(6) An eligible household with a date of application after the 15th of the month is issued an initial allotment which combines the initial month’s allotment and the first regular month’s allotment. No further benefits will be issued until the second full month.
NOTE: If a household files an application with less than a 30 day break since their previous participation, the resulting benefits do not qualify for the combined two month allotment provision.
Table of Percentages for Proration 28-Day Month | 29-Day Month | 30-Day Month | 31-Day Month Day Percent | Day Percent | Day Percent | Day Percent 1 | 100.00 | 1 | 100.00 | 1 | 100.00 | 1 | 100.00 2 | 96.43 | 2 | 96.55 | 2 | 96.67 | 2 | 96.77 3 | 92.86 | 3 | 93.10 | 3 | 93.33 | 3 | 93.55 4 | 89.29 | 4 | 89.66 | 4 | 90.00 | 4 | 90.32 5 | 85.71 | 5 | 86.21 | 5 | 86.67 | 5 | 87.10 6 | 82.14 | 6 | 82.76 | 6 | 83.33 | 6 | 83.87 7 | 78.57 | 7 | 79.31 | 7 | 80.00 | 7 | 80.65 8 | 75.00 | 8 | 75.86 | 8 | 76.67 | 8 | 77.42 9 | 71.43 | 9 | 72.41 | 9 | 73.33 | 9 | 74.19 10 | 67.86 | 10 | 68.97 | 10 | 70.00 | 10 | 70.97 11 | 64.29 | 11 | 65.52 | 11 | 66.67 | 11 | 67.74 12 | 60.71 | 12 | 62.07 | 12 | 63.33 | 12 | 64.52 13 | 57.14 | 13 | 58.62 | 13 | 60.00 | 13 | 61.29 14 | 53.57 | 14 | 55.17 | 14 | 56.67 | 14 | 58.06 15 | 50.00 | 15 | 51.72 | 15 | 53.33 | 15 | 54.84 16 | 46.43 | 16 | 48.28 | 16 | 50.00 | 16 | 51.61 17 | 42.86 | 17 | 44.83 | 17 | 46.67 | 17 | 48.39 18 | 39.29 | 18 | 41.38 | 18 | 43.33 | 18 | 45.16 19 | 35.71 | 19 | 37.93 | 19 | 40.00 | 19 | 41.94 20 | 32.14 | 20 | 34.48 | 20 | 36.67 | 20 | 38.71 21 | 28.57 | 21 | 31.03 | 21 | 33.33 | 21 | 35.48 22 | 25.00 | 22 | 27.59 | 22 | 30.00 | 22 | 32.26 23 | 21.43 | 23 | 24.14 | 23 | 26.67 | 23 | 29.03 24 | 17.86 | 24 | 20.69 | 24 | 23.33 | 24 | 25.81 25 | 14.29 | 25 | 17.24 | 25 | 20.00 | 25 | 22.58 26 | 10.71 | 26 | 13.79 | 26 | 16.67 | 26 | 19.35 27 | 7.14 | 27 | 10.34 | 27 | 13.33 | 27 | 16.13 28 | 3.57 | 28 | 6.90 | 28 | 10.00 | 28 | 12.90 29 | 3.45 | 29 | 6.67 | 29 | 9.68 30 | 3.33 | 30 | 6.45 31 | 3.23
Transitional Food Assistance (TFA) benefits are a fixed monthly amount of Food Supplement benefits that are provided for up to five months to certain families whose TANF cash assistance has ended. TFA eligibility is based on the TANF closure so the household must have received TANF or TANF/PaS cash assistance within the past 30 days and Food Supplement Program benefits within the past 60 days to be considered for TFA eligibility. The household does not have to lose eligibility for regular Food Supplement benefits to become eligible for TFA, however, the household cannot receive TFA and regular Food Supplement benefits at the same time.
All included members in an open Food Supplement household, that includes at least one member from a TANF financial assistance group at the time the TANF closes, are eligible for TFA.
Approved TANF closure reasons are:
1. Gross or net income over limits; or
2. Increase in work hours, transitional services.
Households eligible for TFA will receive a TFA Start Letter, which contains information about who is eligible for TFA, the amount of the benefit, how the benefit was determined, and the length of the TFA period. The letter will also explain the process for reporting household changes for those receiving TFA. Households will be notified that they are not required to report any changes in circumstances until the time that they must apply for recertification. Finally, the letter will notify families that their benefit allotment can be changed if the household experiences a decrease in income, an increase in expenses or an increase in household size that could lead to a higher Food Supplement allotment.
Households are not eligible for TFA if TANF cash assistance closed in part or solely due to any of the following:
1. a sanction, being a fugitive felon, or Intentional Program Violation;
2. a transfer of assets or property to qualify for assistance;
3. failure to cooperate with quality control or child support;
4. failure to provide verification required to determine eligibility;
5. not residing in Maine;
6. a case head has left the household.
Households in which all members are ineligible for the Food Supplement Program are also ineligible for TFA.
Individuals ineligible or excluded from the Food Supplement Program at the time that TFA is initially determined will remain ineligible for the duration of the TFA period.
The TFA benefit amount is based on information already known at the time the TANF ends. No further contact is required with the household until the end of the TFA period.
The TFA benefit amount is determined by using the Food Supplement Program budget for the last month that TANF cash was issued and deducting the TANF grant that the household is no longer receiving.
The resulting net income is used to calculate the TFA benefit amount.
The TFA benefit amount is frozen for the duration of the TFA period regardless of any changes to the household’s circumstances. See Transitional Food Assistance Requirements and Changes During the Transitional Food Assistance (TFA) Period below.
EXCEPTIONS: Only under the following circumstances are TFA benefits recalculated during the TFA period:
federally mandated updates to Food Supplement Program allotments and deductions in October;
recoupment; and
3. if a member of an TFA household moves out and either reapplies on their own or is reported as a new member in another Food Supplement household.
The TFA benefit period begins the first month following the last month TANF financial assistance was received and continues for five consecutive months, unless during the TFA period the household:
1. opens for TANF cash;
2. reapplies for regular Food Supplement Benefits; or
3. requests that TFA close.
The recertification period for Food Supplement Program will be reset to match the last month of TFA at the time the household is found eligible for TFA. See FS 666-8, Shortening a Certification Period.
Households will be mailed a special review form the end of month four of the TFA period. Households must recertify for regular Food Supplement benefits by completing the review form during TFA month five to have eligibility for regular Food Supplement benefits redetermined. During the recertification, all changes that were reported during the TFA period, and any new information, will be used to determine ongoing Food Supplement Program eligibility. If the household fails to complete and submit the review form or reapply, TFA automatically terminates on the last day of month five.
There are no work registration requirements or ABAWD work requirements during the TFA period.
If the household only receives TFA, and is not open for another assistance program, the household has no reporting requirements. If the household is open for other programs in addition to TFA, the household must continue to report all changes as required by those programs.
Since TFA benefits are frozen and cannot be altered during the TFA period, any changes acted upon for other programs will not impact the TFA benefit amount. See EXCEPTIONS on previous page.
If a household experiences a decrease in income, an increase in expenses, or an increase in household size, the household’s benefits could potentially be higher if the household stopped TFA and requested regular Food Supplement benefits. Because benefits are frozen during the TFA period, the household must reapply for regular Food Supplement benefits to have the household’s benefit allotment amount changed.
TFA will automatically end under the following circumstances:
1. the household opens for TANF cash;
2. the household reapplies for regular Food Supplement benefits. See Changes During the Transitional Food Assistance (TFA) Period above; or
3. the household fails to complete and submit the review form during month five of the TFA benefit.
Households must report, by the tenth of the month following the month the change occurred if:
A. their monthly household gross income exceeds 130% of the federal poverty level (FPL) (Section 999-3 Chart 2).
B. Any household that contains an ABAWD (see Section 111-7) who is employed must report when the ABAWD’s weekly hours fall below 20.
C. Any individual(s) win, in a single game, gross gambling or lottery winnings equal to or in excess of the figure found in Section 999-3 Chart 9 for Non-Categorical Households with a member who is elderly or has a disability.
Households are not required to report any other changes for SNAP except at annual eligibility review and six-month report.
A. Households in which all adult members are elderly or have disabilities with no earned income at certification are not required to complete a six-month report.
B. All other households must complete a six-month report. Information reported on the six-month report must reflect current household status.
C. The Department shall send households who are required to submit a six-month report, a six-month report prior to the end of the fifth month of their certification period.
D. The six-month report is not a recertification, therefore:
(1) Reported changes that result in a decrease in benefits or closure need to receive adverse action and advance notice.
(2) Reported changes that result in a decrease in benefits (e.g., increases in income, decreases in household size or expenses) do not require verification.
(3) Changes to mandatory items, per Section 222-5(2), that result in an increase in benefits (e.g., decreases in income), may only be made if they are verified.
(a) Recipients may be asked to submit verification; however, they are not required to do so. The Department shall inform recipients of the advantage of submitting verification of changes that increase benefits.
(b) If verification is received after the processing of the six-month report and it results in an increase to the benefit amount, the increase takes effect the month the verification was received. The household may be eligible for a supplement.
(4) Only the questions on the six-month report need to be answered or reported.
E. The Department shall send a reminder notice to households during the sixth month if the six-month report has not been received by the filing date.
F. Failure of the household to return the report prior to the end of the sixth month results in closure of SNAP benefits. The benefits will remain closed unless the report is submitted during the seventh month or the household reapplies for benefits.
G. If a six-month report is submitted late, but received by the Department in the seventh month the end date of the certification period will not change and benefits for the seventh month will not be prorated, if the household is otherwise eligible.
Households that do not submit their six-month report by the end of the seventh month of the certification period will need to reapply if they want benefits to continue. A six-month report received after the seventh month cannot be accepted as an application or reapplication.
A. The Department shall act on verified changes as they become known to the Department. Changes that are considered verified upon receipt, such as verified changes reported by the household, changes reported by the Social Security Administration, the Division of Support Enforcement and Recovery and the Department of Labor Bureau of Unemployment Compensation will be acted on whether they increase or decrease benefits. If reported changes cannot be considered verified upon receipt, the Department will not act on the change unless required by another program in which the household is participating.
B. Changes acted on for other programs for a household receiving SNAP benefits must be acted on for SNAP. If the Department requests verification from the household to clarify circumstances for another program and the household fails to respond to that request, the Department must consider the impact on SNAP benefits according to Section 222-5.
C. At any time during the certification period, changes that are reported, whether as part of the annual eligibility review, as mandatory reporting or as a voluntary report will be acted upon in the following manner:
(1) Reported changes that result in a decrease in benefits or closure do not require verification, unless questionable. The Department shall provide adverse action and advance notice of the decrease. If the reported change is considered questionable as defined in Section 999-1 the Department may require verification for benefits to continue. If the household is expected to be ineligible for only one month, the case is suspended.
NOTE: If any responsible member provides information that results in ineligibility for the household or a member of the household, requests that the action take effect immediately, and signs a statement affirming so, the action shall be taken immediately.
(2) Changes that result in an increase in benefits (e.g., decreases in income) must not be made without verification if it is a mandatory item per Section 222-5(2) or the information is considered questionable as defined in Section 999-1. If no verification is necessary the increase is effective the month the change is reported. The household may be eligible for a supplement.
(a) Recipients may be asked to submit verification; however, they are not required to do so. The Department shall inform recipients of the advantage of submitting verification of changes that increase benefits.
(b) If verification is received and it results in an increase to the benefit amount, the increase takes effect the month the verification was received. The household may be eligible for a supplement.
D. During the certification period, information on household circumstances may be received that requires clarification or verification in order to determine a household’s continued eligibility for benefits. Unclear information can be either not verified or verified but still requiring additional information to act on it. Unclear information will be processed as follows:
(1) If the unclear information is received other than at application or annual eligibility review and the change is less than 60 days old from the current month of participation and would have met the requirements for a reportable change, as stipulated in 1 above, the Department shall send a letter which informs the household about the required verification needed to clarify household circumstances, with a 10-day time frame in which to respond.
Failure to respond will result in a notice of adverse action to close the case and advise the household they may be required to submit a new application if they want to continue to participate in SNAP.
(2) If the unclear information significantly conflicts with the information used by the Office for Family Independence (OFI) staff to determine eligibility at the time of certification, then the Department shall send a letter which informs the household about the required verification needed to clarify household circumstances, with a 10-day time frame in which to respond.
Failure to respond will result in a notice of adverse action to close the case and advise the household they may be required to submit a new application if they want to continue to participate in SNAP.
(3) If the unclear information is received as a result of a data match with the prisoner verification system or the deceased matching system, and the department cannot verify the information, then the Department shall send a letter which informs the household about the required verification needed to clarify household circumstances, with a 10-day time frame in which to respond. Collateral contacts will not be used to verify data matches with out the household’s consent.
Failure or refusal to respond will result in closure of the SNAP case.
(4) If the unclear information does not meet the criteria for numbers 1 or 3, above, OFI staff will not act on the information or require the household to provide any verification related to this information until the next annual eligibility review.
When a change is reported by the household, and it would have resulted in a benefit increase for the month in which it is reported had the allotment not already been authorized, the Department shall issue a supplemental allotment. The amount is calculated based upon the difference between the amount already authorized and the amount the household would have received based upon the circumstances in the month the change is reported.
NOTE: This means that when a change is reported by the household during the certification period, a determination of whether or not a supplement is required must be made based solely on the circumstances in the month in which the change is reported. It is conceivable that a reported change could result in a decrease in next month's benefits and a supplement for the month it was reported.
Under no circumstances should a supplemental allotment be calculated based simply upon the difference between "this month's allotment compared to next month's allotment".
The Department shall authorize supplements no later than 5 days after the change is reported and if necessary verified, whichever is later. Households are entitled to the supplement whether or not the change is reported within 10 days of its occurrence. They are entitled to the supplement when the change is reported during the annual eligibility review process.
GENERAL RULE - Certain changes are initiated by the State or Federal government which may affect all or most of the caseload. These changes include, but are not limited to:
1. adjustments in the Thrifty Food Plan.
2. adjustments in the standard deduction.
3. adjustments in the shelter/dependent care deduction.
4. adjustments in the income eligibility standards.
5. periodic adjustments to TANF or PaS payments.
Advance notice of adverse action is not required when a household's benefits are reduced or terminated as a result of a mass change. The household shall receive adequate notice not later than five days before benefits would normally be received.
*EXCEPTION: Adverse actions resulting from computer to computer matching concerning mass changes to Federal benefits, other than Social Security and SSI, require an advance notice of 30 days.
GENERAL RULE - Establish a definite period of time which the household shall be eligible to receive Food Supplement benefits. At the expiration of each certification period entitlement to benefits ends. At initial application, the first month of the certification period shall be the month of application. Certification periods shall conform to calendar months and shall not be more than twelve (12) months.
NOTE: Food Supplement Program (FSP) applicants and recipients receiving TANF/PaS and MaineCare shall be assigned a common re-determination period based upon FSP criteria. Categorically eligible TANF/PaS households shall have their FSP benefits terminated for failure to complete a re-determination even though they continue to receive TANF/PaS or SSI benefits. When TANF/PaS benefits are terminated within the certification period, and the agency does not have sufficient information to determine the effect upon FSP eligibility and benefit level, the following actions shall be taken:
Wait until it is certain that the TANF/PaS benefits will be closed for at least one month.
Unless the certification period expires by the end of the following month, send a notice of expiration which informs the household that its certification period will expire at the end of the month following the month the notice of expiration is being sent, and that its certification period is expiring because of changes in its circumstances which may affect its FSP eligibility and benefit level.
All households shall be assigned a twelve (12) month certification period.
SHORTENING A CERTIFICATION PERIOD
There are only three basic instances when the State can shorten a certification period:
1. When the State received information which indicates the household is ineligible,
2. When a household is found eligible for Transitional Food Assistance (TFA) and the recertification month is pushed back to match the last month of TFA, or
3. When the household does not cooperate in clarifying its circumstances.
For #1 & #3 only, a contact letter must be sent giving ten (10) days to respond. If the household does not respond, or responds and refuses to provide information, a notice of adverse action is sent for termination.
The right to participate ends with the last day of the certification period. The Department shall provide each household a notice of expiration by the beginning of the last full month of the certification period. Benefits shall not be continued beyond the certification period unless the Department determines the household is still eligible. For the Department to make a determination that the household is ineligible, or still eligible, the household must —
A. submit a signed renewal form on paper, electronically, or telephonically,
B. provide any necessary verifications; and
C. complete an interview with the following exceptions:
(1) The Department shall process all annual eligibility reviews without an interview until the earlier of March 31, 2023 unless—
(a) the household requests an interview,
(b) there is unclear information on the renewal form, or
(c) the household would be determined to be ineligible based on information provided on the renewal form.
(2) Households which have no earned income and in which all adult members are elderly and/or have disabilities will not be required to complete an interview at annual eligibility review unless —
(a) there is unclear information on the renewal form, or
(b) the household would be determined to be ineligible based on information provided on the renewal form.
The Department will conduct an interview if the household requests one.
NOTE: Advance notice of adverse action is not required when benefits change from one certification period to another.
A. The household is considered to have met the requirements of a timely review if they:
(1) file the renewal form by the 15th day of the last month of the certification period,
(2) complete an interview, if required, by the end of the certification period, and
(3) submit necessary verifications by the later of ten calendar days of the request or the end of the certification period.
B. If the household meets the requirements of a timely review, the Department shall determine eligibility and notify the household of the Department’s determination by the end of the household's current certification period. The Department shall allow eligible households to continue their normal issuance cycle in the month following the end of their current certification period.
C. If, due to the time allowed for submitting requested verification, the Department is unable to determine a household’s eligibility in time for an eligible household to participate in their normal issuance cycle, the Department shall allow any eligible household to participate within five working days after the household submits the missing verification.
A. The household shall lose their right to uninterrupted benefits for failure to—
(1) file the renewal form by the 15th day of the last month of the certification period,
(2) complete a scheduled interview, if required, prior to the end of the certification period, or
(3) submit requested mandatory verifications by the later of ten calendar days of the request or the end of the certification period.
B. If the household loses their right to uninterrupted benefits due to such failures but is otherwise eligible after correcting such failures, the Department shall provide benefits within the later of—
(1) 30 days after the renewal form is filed,
(2) ten days of the date the required interview is completed, or
(3) ten days of the date the required verification is provided.
C. If the household does not file the renewal form until after the end of the previous certification period, the allotment to be issued for the initial month of the new certification period shall be prorated from the date the renewal form is received, per the process at Section 555-6(2)(B).
The Department shall process denials —
A. on the last day of the current certification period if continued eligibility cannot be determined prior to that date, or the household is ineligible and no interview could be completed,
B. within 30 days after the date the renewal form was filed untimely, if the household is ineligible and no interview could be completed, or
C. within ten days of determining the household is ineligible, if an interview has been completed and the household fails to provide requested mandatory verifications timely.
A. The household must provide verification of the following —
(1) income if the source has changed or the amount has changed by more than $50 per month,
(2) allowable medical expenses which were previously unreported or which have changed by more than $25 per month,
(3) the legal obligation to pay child support, including the obligated amount, and the amount paid,
(4) utility expenses when the household is not eligible for a utility allowance, and the amount has changed by more than $25 per month, and
(5) information which is contradictory to information known to or received by the Department or is otherwise considered questionable as defined in Section 999-1 including, but not limited to, factors affecting the composition of a household.
B. Acceptable verification is not limited to any single type of document. The Department may obtain verification from the household or other sources. Whenever documentation cannot be obtained, is contradictory to information known to or received by the Department, unclear, or insufficient to make a determination of eligibility or benefit level, the Department shall require collateral contacts.
A. Participating households which meet the "timely review" standards listed in 666-9(2) shall be mailed an adequate notice of the Department’s determination by the end of the household's current certification period.
B. Participating households which do not meet the “timely review” standards shall be mailed an adequate notice of the Department’s determination within 30 days after the date the renewal form was filed.
GENERAL RULE - Do not restore benefits more than twelve (12) months prior to the month the agency becomes aware of the underpayment or is notified of the reversal.
When an underpayment is identified, take action to restore benefits when:
- the underpayment was caused by the agency;
- a disqualification for intentional program violation is reversed, or special instructions state that a household is entitled to a restoration of lost benefits.
A household is entitled to restored benefits, even if it is not currently receiving FS.
Installments may be made to restore lost benefits. An accounting system for documenting entitlement to restored benefits and for recording the balance must be maintained.
A fair hearing may be requested when the client is dissatisfied.
In order to restore benefits determine the time period to be covered in the restoration.
1. Regardless of the time period of lost benefits, restoration cannot cover more than a twelve (12) month period. Restoration may be made:
- back to the date of application when erroneously denied.
- back to the first month that benefits were not received when benefits were erroneously terminated.
- for the months the household was underpaid.
The difference between what the household received and what it should have received equals the amount to be restored.
2. Establish eligibility for each month's benefit separately.
3. Subtract any amount owed the agency due to any previously established claim for overpayment, regardless of cause of overpayment.
4. If the household's membership has changed, restore the benefits to the household containing the majority of the household members at the time the error occurred. If this cannot be determined, restore benefits to the person who was the head of household at the time of the error.
GENERAL RULE - A household has an opportunity for a fair hearing when it disagrees with actions affecting its benefits. Any request for a fair hearing must be made within ninety days of the date of the action. The Department may waive time limits. Requests for hearings may be made orally or in writing at the Regional Office or at the Central Office. All decisions of fair hearing officials are binding on the Department.
NOTE: Clients who are dissatisfied with any action shall be given the opportunity to discuss their case with the immediate supervisor. The household shall be advised that this meeting with the supervisor is optional and will not delay or replace a fair hearing.
TIME LIMITS ON HEARINGS - The Department has sixty days from the date of the request for a hearing to hold the hearing, render the decision, and notify the household. Decisions will be implemented immediately.
The household can have the hearing postponed for up to thirty days. The time limit is extended accordingly.
NOTE: Hearing requests from households planning to move from the area within sixty days shall be processed faster than normal to enable a decision and possible restoration of benefits before they leave.
1) Provide without charge the specific Department documents requested by the client or his representative.
2) Provide a translator, if necessary.
3) Advise the household of legal services available.
DENIAL/DISMISSAL - The Administrative Hearings Unit shall not deny or dismiss a hearing request unless:
1) the request is not received within ninety days of the action.
2) the request is withdrawn.
3) the household or its representative fails to appear at the scheduled hearing, and does not present evidence that his absence was beyond his control.
CONTINUATION OF BENEFITS - If a household requests a hearing within twelve days of the notice, and the certification period has not expired, benefits shall be continued as authorized immediately prior to the notice unless the household waives continuation of benefits.
If the hearing request is not made within twelve days, benefits shall be reduced or terminated, as stated in the notice.
NOTE: If the Department is upheld, a claim against the household shall be established for all over-issuances which resulted from the continuation of benefits.
CHANGING BENEFITS PENDING A HEARING DECISION - Benefits shall not be changed prior to the hearing decision unless:
1) the certification period expires.
2) a subsequent change affects the household's benefits.
3) a mass change occurs, affecting the household's eligibility or benefit level.
NOTIFICATION OF HEARING - The time, date, and place of the hearing shall be arranged so that the hearing is accessible to the household. Written notice to all parties shall be provided at least ten days prior to the hearing. The notice shall:
1) give the time, date, and place of the hearing.
2) give the name, address, and telephone number of the person to notify if it is not possible for the household to attend.
3) specify that the Department will dismiss the request if the household or its representative fails to appear without good cause.
4) include the hearing procedures.
5) state that the household or its representative may examine the case file prior to the hearing.
THE HEARINGS OFFICER - Hearings shall be conducted by a Department hearing officer. The hearing officer shall:
1) administer oaths to all witnesses.
2) ensure that all relevant issues are considered.
3) request, receive, and make part of the record all necessary evidence.
4) regulate the hearing consistent with due process.
5) render a decision.
ATTENDANCE AT THE HEARING - The hearing shall be attended by at least one agency representative and at least one household representative.
1) The household shall be given an opportunity to examine all evidence at a reasonable time before the hearing, as well as at the hearing. The contents of the case file shall be made available.
EXCEPTION: Do not disclose the names of persons who have informed on the household and do not disclose the nature or status of any pending criminal prosecutions. Information that is protected from release cannot be presented at the hearing.
2) Present the case itself or have it presented by a legal counsel or other person.
3) Bring witnesses.
4) Advance arguments without undue interference.
5) Submit evidence to establish all pertinent facts and circumstances in the case.
6) Subpoena witnesses.
THE HEARING DECISION - The decisions of the Hearings Unit shall comply with the Federal law and regulations, and shall be based on the hearing record. The verbatim transcript or recording of testimony and exhibits, or an official report containing the substance of what transpired at the hearing, together with all papers and requests filed in the official proceeding, shall be retained for three years. This record shall also be available, upon request, to the household or its representative at any reasonable time for copying and inspection at no cost.
A decision by the Hearings Unit shall be binding on the Department and shall summarize the facts of the case, specify the reasons for the decision, and identify the pertinent Federal regulations. The decision shall become part of the record.
GENERAL RULE - Any suspected program violation shall be investigated. When there is sufficient documentary evidence to substantiate that the violation was intentional, initiate an administrative disqualification hearing, regardless of the current eligibility status of the individual. A second party, preferably the immediate supervisor, shall review the evidence prior to initiating a disqualification hearing.
Do not initiate any collection activity until a determination has been made as to whether or not an IPV has occurred.
Federal rules at 7 CFR 273.16(c) state that an intentional program violation has been committed when:
1. A false or misleading statement has intentionally been made.
or
2. A household member has intentionally misrepresented, concealed, or withheld facts.
or
3. A household member has intentionally committed any act that constitutes a violation of the Food Stamp Act, the Food Stamp Program Regulations, the Food Supplement Program regulations or any state statute relating to the use, presentation, transfer, acquisition, receipt, trafficking (see FS 999-1 pages 5 and 6), or possession of the food supplement benefit.
The IPV determination can be made by a department hearing officer, a signed Waiver of Hearing, or a judge. The Eligibility Specialist may choose to begin the disqualification process with an interview, at which time the accused individual may choose to sign a Waiver of Hearing.
NOTE: While most Intentional Program Violations result in a monetary loss to the program, a household’s willful misrepresentation is sufficient grounds to pursue an IPV even when no overpayment of Food Supplement benefits occurred.
If it is determined that the violation does not meet the definition of a IPV, collection action shall be initiated as an unintentional or agency claim, as appropriate.
Individuals determined to have committed an IPV through the administrative disqualification process are automatically referred to the Fraud Investigation and Recovery Unit (FIRU) via the computer, when IPV overpayments are input into the computer system. FIRU staff consider these individuals for prosecution.
NOTE: Do not delay the FS disqualification penalty and collection action pending prosecution.
Written notice to the person accused of the violation shall be mailed at least 45 days in advance of the scheduled hearing in order to assure that the notice is received 30 days prior to the hearing. The first notice shall be mailed "CERTIFIED/RETURN RECEIPT REQUESTED/RESTRICTED DELIVERY". The notice shall contain:
1) the date, time and place of the hearing.
2) the charges against the household member.
3) a summary of the evidence, and how and where it can be examined.
4) a warning that the decision will be based solely on information provided by the Food Supplement Program office if the household fails to appear at the hearing.
5) a statement that the household member or representative will have 10 days from the date of the scheduled hearing to present good cause for failure to appear in order to receive a new hearing.
6) a warning that a determination of intentional program violation will result in a 1 year disqualification for the 1st violation (six months if the alleged IPV offense occurred before 8/22/96), 2 year disqualification for the 2nd violation (one year if the alleged IPV offense occurred before 8/22/96), and permanent disqualification for the 3rd violation and a statement of which penalty is applicable to the case scheduled for a hearing.
NOTE: To determine the approximate disqualification period, the Disqualified Recipient Subsystem (DRS) must be checked for prior IPV(s) in other states. If it is discovered that an IPV occurred in another state, independent verification of the IPV must be obtained and notice provided to the applicable household member before the DRS information can be used in determining an appropriate disqualification period for any subsequent IPV. A recipient has the right to request a fair hearing if the recipient disagrees with the length of the disqualification that DRS indicates was imposed by a State. However, the fair hearing cannot reverse a determination established at a previous administrative disqualification hearing that the recipient has committed an Intentional Program Violation.
A copy of the hearings procedures and the opportunity to waive the right to the hearing shall also be provided.
The person is entitled to one postponement, provided it is requested at least 10 days prior to the scheduled date. The postponement shall be for no more than 30 days. Requests for postponements within 10 days of the scheduled date may be granted, provided both the local office and the accused agree in writing.
If the notice is returned marked "undelivered" or accepted by someone other than the addressee, personal service shall be arranged by any other method which provides proof of receipt at least 30
days prior to the hearing. It will be necessary to reschedule the hearing, allowing another 45 days. Hearings will be scheduled and arranged by the local office, and will be held on Mondays and Fridays. Copies of all notices and waivers will be sent to the Hearings Unit. When the accused replies that he wants a hearing, the Hearings Unit shall be notified of the time and place.
If the notice is returned marked "refused", it shall be assumed that the addressee received notice.
Should the client fail to appear at the hearing, and the notice was received at least 30 days prior to the hearing date, the hearing shall still be conducted. The hearing officer will base his decision on the evidence presented by the Department.
TIME LIMITS - The Department has ninety days from the date the hearing notice is received to hold the hearing, render the decision, and notify the household.
PARTICIPATION PENDING A HEARING - Continued eligibility and benefit level shall be determined, as for any other household.
CRITERIA FOR DETERMINING INTENTIONAL PROGRAM VIOLATION - The hearing officer shall base the determination on clear and convincing evidence which demonstrates that the household member committed, and intended to commit, an intentional program violation as defined at 7 CFR 273.16 (c) and page 1 of this section of the Maine Food Supplement Manual.
DISQUALIFICATION PENALTIES - The disqualification applies to the individual who was determined to have committed an intentional program violation. The disqualification period will begin with the first month which follows the date the household member is sent written notification of the disqualification that results from the hearing decision. The disqualification periods are as follows:
1) first violation - 1 year (6 months if the alleged IPV offense occurred before 8/22/96);
2) second violation - 2 years (one year if the alleged IPV offense occurred before 8/22/96);
3) third violation - forever.
Certain intentional program violations carry more severe penalties. Those violations and their disqualification periods are as follows:
1) a first finding by a court that the recipient used Food Supplement benefits or FS EBT card in exchange for controlled substances - 2 years;
2) a second finding by a court that the recipient used Food Supplement benefits of FS EBT card in exchange for controlled substances - forever.
3) a first finding by a court that the recipient has used Food Supplement benefits or FS EBT card in exchange for firearms, ammunition, or explosives - forever.
4) conviction of the individual for trafficking (see FS 999-1 pages 5 and 6) Food Supplement benefits or FS EBT of $500 or more - forever.
5) a finding by a hearing officer or court that a fraudulent representation was made by an individual with respect to his/her identity or place of residence in order to receive multiple (simultaneous) Food Supplement benefits - 10 years.
See FS 444-4 for treatment of income and assets of disqualified individuals.
NOTE: All disqualifications for violations committed prior to May 1, 1983, will be counted as a single violation for purposes of determining penalties.
NOTIFICATION OF DECISIONS - When the household member is determined to have committed an IPV, a written notice shall be provided prior to the disqualification. It shall note the date the disqualification begins and ends. Advance notice is not required. See FS 777-3 for collection action.
DISQUALIFIED RECIPIENT SUBSYSTEM (DRS)
DRS is a centralized national database which contains information on IPV disqualifications from all of the states. Updates are received by the national database and matched with Maine's Food Supplement Program caseload on a monthly basis. When a match occurs, the originating state must be contacted for independent verification of the IPV disqualification information. This information must be used to determine if a recipient should be serving a disqualification period imposed by another state and to determine the proper disqualification penalty for an individual found or suspected to have committed an IPV. The originating state should be asked whether the IPV disqualification is under appeal and requested to inform you if the IPV disqualification is reversed. If an IPV disqualification is reversed, the individual must be reinstated if the household is eligible and benefits lost as a result of the disqualification must be restored.
A recipient has the right to request a fair hearing if the recipient disagrees with the length of the disqualification that DRS indicates was imposed by a State. However, the fair hearing cannot reverse a determination established at a previous administrative disqualification hearing that the recipient has committed an Intentional Program Violation.
Once a disqualification period has been imposed against a currently participating member, the disqualification period continues uninterrupted until completed. The household would be subject to a claim for any benefits overissued as a result of the disqualified individual's participation during the period of disqualification.
A household shall be determined ineligible if it refuses, without good cause, to cooperate in any reviews generated by reported changes and recertifications. The household shall be ineligible until it cooperates with the Department.
All subsequent applications or redeterminations shall result in ineligibility for all households that include a member who was an adult member of a household which was determined ineligible as a result of a refusal to cooperate. Good cause provisions apply (e.g. adults separated due to domestic violence, adult child who cannot get a parent’s income verification, etc.)
NOTE: Refer to Sections 222-1 and 222-5 for further guidance.
A. A claim may be established against any household that has received more benefits than entitled. There are three classifications of claims:
(1) Agency - An overpayment which was the result of a Departmental mistake, or failure to act in a timely manner.
(2) Intentional - An overpayment which was the result of a household member intentionally violating a program regulation. This determination must be made by a hearing officer, a court, or a Waiver of Hearing signed by the member.
NOTE: A guilty verdict or a plea of guilty to a criminal charge based on the same conduct that satisfies the criteria for an intentional violation shall suffice to establish such a violation administratively. The amount of the overpayment and corresponding amount due to the Department shall be the amount specified in the letter of debt to the household, irrespective of any Court order of restitution.
(3) Inadvertent Household - An overpayment which was the result of a misunderstanding on the part of the household.
B. The Department shall not establish an overpayment when:
(1) The Department failed to ensure that a household fulfilled the following procedural requirements:
(a) Sign the application form; or
(b) Complete a work referral form.
(2) A household was not required to report a change which results in reduced benefits or ineligibility for benefits.
(3) The overpayment is caused by an Agency or Inadvertent Household error, has a dollar value of $500 or less as determined per Paragraph 6(A) below, and the household is not participating when the over issuance is calculated.
(4) The overpayment is caused by an Agency or Inadvertent Household error, has a dollar value of $200 or less as determined per Paragraph 6(A) below, and the household is participating when the over issuance is calculated, or
(5) The overpayment is caused by an Agency or Inadvertent Household error that occurred on or after March 1, 2020 and during the Federal Public Health Emergency related to 2019-nCoV declared by Secretary Azar on January 31, 2020 which ended May 11, 2023.
EXCEPTION: All overpayments resulting from either a Quality Control review or trafficking must be established regardless of the amount, cause, or timing. (See definition of trafficking in Section 999-1.)
NOTE: In situations where there are overpayments for both State funded benefits and Federally funded benefits, the overpayment attributable to the Federally funded benefits are collected first.
A. If a household requests a fair hearing due to an initial demand notice, collection activity is to stop pending the fair hearing decision.
B. If a hearing officer decides that an overpayment exists against the household, the household must be re-notified of the overpayment and they do not have hearing rights on the same issue.
C. If the amount of an overpayment was not determined prior to, or with the fair hearing decision, the claimant has the right to request a fair hearing on the amount of the overpayment as stated in the re-notification.
The Department may determine claims for overpayments for past months, the current month, or months that will be overpaid due to time limits on adverse action. The required time frame is determined by the type of claim.
A. Agency - As far back as 12 calendar months prior to the month the overpayment was discovered and forward until the benefit amount can be corrected.
B. Intentional - As far back as 72 calendar months prior to the month the overpayment was discovered and forward until the benefit amount can be corrected.
C. Inadvertent Household - As far back as 24 calendar months prior to the month the overpayment was discovered and forward until the benefit amount can be corrected.
A. The Department shall determine the amount to be recouped.
(1) The amount to be recouped as the result of trafficking, is the amount of SNAP benefits involved in the trafficking.
(2) For all other overpayments—
(a) The Department shall determine what the benefit would have been had the household or the Department acted correctly; When determining the amount of the claim for claims established after 10/31/96, the earned income deduction is not applied to that portion of earned income which the household intentionally failed to report; or, failed to report in a timely manner.
(b) This amount is subtracted from the benefit that was actually received. The difference is the amount to be recouped.
NOTE: The calculation must include a separate amount to be applied to individuals who were members of the household for only part of the overpayment period , or were under 18 years of age for part of the overpayment period. This separate amount is applied to those individuals if they cease to be members of the overpaid SNAP household before the full amount is recouped.
B. The Department shall apply appropriate compromises.
A possible compromise of an overpayment shall be assessed and applied when the overpayment is calculated, if eligible.
(1) To qualify for compromise of an overpayment, two requirements must be met. If either of these is not met the household will not be eligible for a compromise. The requirements are:
(a) The overpayment must have been caused by an Agency or Inadvertent Household error; and
(b) The Department determines that, as of the month of calculation, the household is not now and is not expected to be able to pay back the overpayment within three years (36 months), using the standards set forth below.
(i) If the household is receiving SNAP benefits:
a) Using the budget as defined in Section 555-6, determine the current Full Month’s benefit amount.
b) Assessing which monthly recoupment amount (ten percent of the benefit or ten dollars), is greater.
c) Determining the total recoupment for a 36-month period, by multiplying the greater figure (ten percent or ten dollars) by 36 months.
(ii) If the household is NOT receiving SNAP benefits:
Using the budget as defined in Section 555-6 to determine the Net SNAP Income (NSI) amount.
Exception: Use of medical expenses greater than $35 per month is not limited to elderly and disabled individuals.
Assessing which monthly recoupment amount (three percent of the NSI or ten dollars) is greater.
Determining the total recoupment for a 36-month period by multiplying the greater figure (three percent or ten dollars) by 36 months.
(2) If the overpayment was the result of trafficking or an Intentional Program Violation, there is no potential for a compromise.
(3) If the total recoupment for a 36-month period is equal to or greater than the current overpayment balance, there is no potential for a compromise.
(4) If the overpayment was caused by an Agency or Inadvertent Household error, and the total recoupment for a 36-month period is less than the current overpayment balance, the current balance of the overpayment will be reduced to the total recoupment for a 36-month period effective for the month following the month of the compromise calculation.
(5) A compromise of an overpayment will not be retroactively applied to any period of repayment (on the same overpayment) prior to the month following the month of the compromise calculation.
(6) The calculation to determine possible compromise of an overpayment is specific to that overpayment. The assessment to determine benefit and NSI amounts does not factor in any obligation to pay other outstanding SNAP overpayments that may exist for the same household.
A. The Department shall pursue collection action against any and all of the adult members of a household at the time an overpayment occurred. SNAP Program recipients responsible for repayment of overpayments are those members of the household at least 18 years of age. A person who attains the age of 18 during the overpaid period is responsible for that portion of the overpayment amount occurring after the attainment of age 18. If a change in household composition occurs, collection action may be pursued against any household which has a member who was an adult member of the household that received the over-issuance. The amount of the initial claim may be offset against restored benefits owed to the household which contains such a member.
B. The Department shall reduce any restored benefits due the household members up to the amount to be recouped and apply those funds to the recoupment balance.
C. The Department shall reduce ongoing benefits to recoup the balance of the claim. Unless a higher rate is requested by the household, the following rates apply:
(1) For Agency or Inadvertent Household error claims, the reduction amount is the greater of ten percent of the monthly benefit, or ten dollars.
(2) For Intentional claims, the reduction amount is the greater of 20% of the monthly benefit, or $20.00.
D. The Department shall send a demand letter detailing the amount to be recouped and the rate of recoupment.
E. The Department shall make a personal contact with the household, as appropriate.
F. Cases with an outstanding claim that are not currently receiving benefits equal to or in excess of the minimum reduction amount shall be referred to The Benefit Recovery Unit (BRU).
A. Payments can be made in the form of SNAP benefits or U.S. currency. Checks, money orders, and credit/debit card payments to Treasurer, State of Maine are accepted.
B. Households are encouraged to repay any claim by a lump sum payment. The household is not, however, expected to liquidate their resources.
C. If the household is not able to pay the entire amount at one time, it is encouraged to repay through installment payments or allotment reduction. SNAP benefits may be used as full or partial payment of any installment.
D. If the household misses a scheduled installment, a notice shall be sent. Renegotiation can be done at any time.
E. If payments are not being made on an outstanding debt, the Department may implore the assistance of other agencies including but not limited the Treasury Offset Program (with the U.S. Internal Revenue Service) and the Maine Revenue Service.
A. If a household has not previously qualified for a compromise of an Agency or Inadvertent Household error overpayment they can request a compromise of that overpayment any time their SNAP benefit amount or NSI have changed. The Department will evaluate the qualification for and amount of the compromise per Paragraph 6(B).
B. Collection attempts on an Inadvertent Household claim involving a closed case may be suspended after one demand letter and filed for future reference.
C. Collection attempts on any Agency claim may be suspended after one demand letter and filed for future reference.
D. BRU may suspend collection attempts on a referred Intentional claim involving a closed case after three attempts. When it does, the originating office shall be notified, and the claim filed for future reference.
A. Outstanding claims may be terminated by BRU after 36 consecutive months with no collection activity. Outstanding balances on terminated claims regardless of the classification, shall be offset before restoration of lost benefits.
B. A claim shall be closed when it has been paid in full.
SNAP benefits reported as not issued to the individual’s EBT Account are replaced only if the error is reported in the period of intended use. The period of intended use of regular monthly allotments is the month of issuance and the next 11 months.
A. Beginning December 20, 2024, the Department will only replace benefits pursuant to the process in Section 777-4(3)(B)-(F), as described below, if the replacement of benefits is federally authorized. If replacement of benefits lacks federal authorization, the Department will also suspend replacement of state funded benefits for the same period. If replacement of benefits is suspended due to a lack of federal authorization, the Department shall promptly notify a claimant of the suspension upon receiving an Electronically Stolen Benefits Application (EBSA) and deny that request.
Benefits used to purchase food can only be replaced when the food has been destroyed due to a household misfortune, such as but not limited to fire or flood, or special disaster declaration by the Secretary of Agriculture. The household must report the loss within ten days of the destruction.
A. The household must complete the SNAP Loss and Replacement Request form within 10 days of the initial report of the loss.
B. The disaster must be verified and documented.
C. The Department shall issue a replacement allotment not to exceed the lesser of the value of the food destroyed or one month's benefit within ten days of receiving the form and the verification.
Benefits used unlawfully for non-household members can only be replaced when the benefits were accessed as a result of card skimming, card cloning, phishing or other electronic acquisition of the EBT card number and PIN.
The household must submit an Electronically Stolen Benefits Application (ESBA) timely.
Claims for benefits stolen electronically on or after October 9, 2023, are timely if they are received within 30 days of the benefits being used.
Claims for benefits stolen on or after October 1, 2022 but before October 9, 2023, are timely if received by November 8, 2023.
Benefits stolen before October 1, 2022, are not eligible for replacement.
The completed ESBA shall include:
the following information about the claimant
their first and last name,
their ACES ID# (or if the claim is being made by an authorized representative, the ACES ID# of the individual they are representing),
(c) another unique identifier, either
the last four digits of their social security number or
their USCIS #,
(d) their address, and
(e) their telephone number;
The following information about the theft of benefits (food purchase)
the date of the theft,
the amount of the theft,
the location of the theft, and
the location of the EBT Card at the time of the theft;
the current location of the EBT Card; and
to the best of the claimant's ability a narrative description of how the card number and PIN were acquired by the thief.
ESBAs can be submitted in person at any Office for Family Independence office, by mail, by e-mail, or by uploading them to the Office’s online portal.
The Department shall process all ESBAs and issue a written determination (consistent with section 777-5) and replacement benefits, if applicable, within ten days of receipt of the Application.
The Department shall use readily available data and other sources of information that will not delay the determination. Claim validation is solely at the discretion of the Department.
The household may request a hearing on the decision consistent with Section 777-1. The Department’s decision stands unless and until overturned by the hearings officer.
The Department shall investigate all reports of fraudulent EBT usage even if the report is not eligible for replacement.
Replacement benefits cannot exceed the lesser of the amount stolen or the total amount issued in the two months preceding the theft.
G. No household may receive replacement of stolen benefits more than two times in any federal fiscal year.
GENERAL RULE - Whenever the agency takes an action affecting the household's eligibility or benefits, an adequate notice shall be provided (FS 999-1).
EXCEPTION: No notice is required when the entire household dies or moves out of State.
NOTE: The Department will use the same procedure when mailing documents or an EBT card to the designated address of a participant in the Address Confidentiality Program (ACP). The administrators of the Address Confidentiality Program will then forward the mail to the ACP participant. Therefore, the ACP participant will experience delays in receiving mail.
APPLICATION NOTICES - Applicant households shall be mailed an adequate notice of the agency's action within thirty days of the application date. The notice shall contain the following:
1. The amount of benefits, including any retroactive payment and the period covered;
2. length of certification.
REDETERMINATION NOTICES - Participating households which meet the "timely redetermination" time standards listed at FS 666-9 shall be mailed an adequate notice of the agency action by the end of the household's current certification period.
Participating households which do not meet the timely redetermination time standards shall be mailed an adequate notice of agency action within 30 days after the date the redetermination form was filed.
ADVANCE NOTICE RESULTING FROM REPORTED CHANGES AND COMPUTER MATCHES OTHER THAN BEERS or IRS - When a change results in a decrease, closure, or suspension, the household shall be mailed an adequate notice at least twelve days in advance of the effective date of the action.
EXCEPTIONS: Advance notice is not required for the following instances:
- the household's address is unknown and mail directed to it has been returned by the post office indicating no known forwarding address, and there has been an attempt to contact the household by phone. If household contacts the Department within 30 days of closure date, benefits can be reinstated.
- a mass change which is not based upon a computer to computer match with Federal records;
- the decrease or closure is solely due to written information provided and signed by a responsible member of the household which includes a request that the action take effect immediately;
- the household voluntarily requests, in writing or verbally to a case worker, that its participation be terminated. If the request is verbal, the caseworker shall send the household a letter confirming the voluntary withdrawal.
- mandatory allotment reduction;
- the household has been receiving restored benefits in installments and the restoration has been completed;
- the decrease or closure is the result of a disqualification for an intentional program violation.
NOTE: Adequate notice of the agency action shall be mailed at least five (5) days prior to the normal issuance date.
ADVANCE NOTICE RESULTING FROM COMPUTER TO COMPUTER MATCHES WITH BEERS or IRS RECORDS When an adverse action is the result of a computer to computer match involving automated BEERS or IRS records, the household shall be mailed an adequate notice at least 30 days in advance of the effective date of the action.
OTHER CHANGE NOTICES When a reported change results in an increase or the benefit remains the same, the household will be mailed an adequate notice at least five days prior to the normal issuance date.
GENERAL RULE - All complaints regarding processing standards and service to program participants, potential participants, or interested individuals or groups shall be directed to the appropriate TANF or PaS/FS Unit Supervisor. The complainant shall be provided a written response within 15 days and a copy shall be forwarded to the Regional Manager. The response shall specify the action taken and that the complainant can further appeal to the Regional Manager. Appeals to the Regional Manager shall be processed and notification made to the complainant within 10 days of the appeal. The notice shall advise that if the complainant is still dissatisfied that he/she can appeal to the Deputy Director, Office for Family Independence for final resolution. A final disposition will be made and the complainant notified within 10 days of the final appeal.
Information about the program complaint system and how to file a complaint shall be made available through pamphlets available at each regional office. Program complaints received through the statewide Food Supplement Program information hot-line will be referred to the appropriate TANF or PaS/Food Supplement Program Unit Supervisor.
EXCEPTION:
1. Complaints about discrimination on the basis of race, sex, age, religious creed, national origin, political beliefs, or handicaps shall be handled as outlined in FS 1 of the Maine Food Supplement Program Manual.
2. Disagreements with agency actions affecting benefits shall be handled through the Fair Hearings process set forth in FS 777-1.
3. Allegations of misconduct or other complaints against an individual employee shall be processed in accord with Article 12 of the Collective Bargaining Contract in effect at the time of the complaint.
Each Regional Manager shall maintain a file or files containing sufficient data to show the disposition of each complaint. Information on each complaint shall be retained for a period of 3 years from the date of the end of the federal fiscal year in which the complaint was filed.
SNAP recipients receive benefits via an Electronic Benefit Transfer (EBT) card known as The Pine Tree Card. The United States Department of Agriculture (USDA) authorized retailer may have a manual voucher system to access the recipients’ benefits. The card is used to access benefits from point of sales (POS) devices or online purchasing systems at USDA authorized retailers.
A. Each Assistance Group case head is issued an EBT card to access SNAP benefits. If separate Assistance Groups have the same case head, only one card is issued.
B. Each Assistance Group is allowed a maximum of two payees to access SNAP benefits.
C. The EBT SNAP account is non-interest bearing.
D. An EBT SNAP account balance that is not used by the recipient in the month of issuance is carried forward.
E. EBT SNAP account balances include both dollars and cents.
F. A recipient cannot use the EBT SNAP account to borrow against future month’s benefits.
G. Monthly benefits are issued during a five day period each month. Recipient’s benefits (excluding supplements) are available on the same date each month once they are on the delivery cycle.
SNAP benefit recipients are issued an EBT card along with written instructions for establishing a Personal Identification Number (PIN). Each card holder selects their own PIN to prevent unauthorized individuals from gaining access to benefits if the card is lost or stolen. The PIN is their electronic signature.
Card holders can make purchases from participating retailers by having their card swiped through a POS device or by providing required information for an online purchase. The POS device or online system “reads” a recipient’s benefit account balance and, if funds are sufficient, approves the transaction and reduces that balance by the exact amount of purchase.
Some retailers, such as some small grocery stores and farmers markets, and Meals on Wheels participants, use a manual voucher system to access SNAP benefits. Recipients sign vouchers instead of using their PIN.
Each time a SNAP recipient makes a purchase, their available SNAP balance appears on their receipt.
Recipients can also obtain their SNAP balance by calling a 24-hour toll free Customer Service Line before shopping. The toll free number is printed on the back of the EBT Card.
SNAP recipients do not incur user fees.
The Department shall expunge unused SNAP benefits 365 days from the date they are issued or the last date some are spent, whichever is later. Starting September 1, 2022, the Department shall expunge unused SNAP benefits 274 days from the date they are issued or the last date some are spent, whichever is later. The Department shall provide a notice to the recipient Assistance Group at least 30 days prior to their benefits being expunged. This notice explains that those benefits will be expunged if no benefits have been used prior to the scheduled expungement date.
If the Department has verified that all household members are deceased, it shall—
A. immediately disable access to the SNAP benefits, and
B. expunge all remaining SNAP benefits within ten business days of verification, without notice.
Card holders can report lost, stolen or damaged cards to the EBT Customer Service Help Desk by calling the toll free number, 1-800-477-7428.
EBT Help Desk Staff status the card as lost, stolen, or damaged.
After the EBT Help Desk Staff appropriately identifies the household member or card holder, a replacement, not deemed excessive as defined below in Paragraph 9(A), is issued as follows:
A. If the individual lives at the same address known to the eligibility database used by the Office for Family Independence (OFI), the help desk authorizes the replacement card, which will be mailed out within three business days following notice by the household that the card has been lost, stolen, or damaged.
The card holder can continue to use the same PIN, or may change the PIN by using the same toll free EBT Help Desk number, or visiting a local OFI office.
B. If the individual’s address changed, the EBT Help Desk does not authorize a card replacement. The caller is told to contact OFI to report the new circumstances. After the individual’s case record is updated, they may follow procedures explained above in Paragraph 8(A).
A. Thresholds for Excessive Requests
Effective April 23, 2020, a fourth request for a replacement card for an Assistance Group within a 12 month period is considered excessive. (See 7 C.F.R. § 274.6(b)(5).)
B. Management of Excessive Requests
(1) Upon reaching the fourth (or more) request for a replacement card, the household is sent a Withhold Replacement Card Warning Notice stating that they have reached the threshold of four or more replacement cards, and that the next request for a card replacement will require contact with OFI to provide an explanation before the replacement card will be issued.
(2) Once the threshold has been exceeded (at the fifth replacement request), the EBT vendor notifies the household in writing that the threshold has been exceeded and that OFI is denying the card replacement until the household contacts OFI to provide an explanation for the replacement requests.
(a) If the household makes contact, the EBT vendor shall put the EBT card in the mail within three business days following the household contact with OFI, regardless of whether an explanation was provided. If an explanation is not provided the household is referred to the Fraud Investigation and Recovery Unity (FIRU) for investigation.
(b) If the household provides an explanation which OFI deems appropriate, OFI educates them on the proper use of the card and does not require contact upon subsequent requests, unless the pattern of card activity has changed since the initial contact and indicates possible trafficking activity. In all cases, OFI acts to protect households containing members who— are experiencing homelessness, are elderly, have disabilities, or are victims of crimes and other vulnerable persons who may lose EBT cards but are not committing fraud.
(c) If the household does not contact OFI in response to OFI’s notice, OFI does not issue a replacement card to the household and the household is referred to FIRU for investigation.
(d) If the household contacts OFI but does not explain the card losses or the explanation provided appears to be indicative of trafficking (see Section 999-1 pages 5 and 6), OFI refers the household to FIRU for investigation. OFI shall issue a replacement card to any household that makes the required contact so that the household has access to benefits in their EBT account while the investigation is underway and while awaiting a hearing (7 C.F.R. § 273.16(e)(5)). If an intentional program violation is found after investigation by FIRU, established disqualification procedures are followed in accordance with Section 777-2.
(3) The same process outlined in Paragraph 9(2)(d) is initiated prior to the threshold for excessive requests being reached if OFI has additional evidence indicating a suspected trafficking violation. (See Section 999-1 pages 5 and 6.)
GENERAL RULE - Federal regulations require that each state maintain and use an income and eligibility verification system (IEVS). Wage and benefit information shall be requested as follows:
1. Wage information maintained by the Maine Employment Security Commission (MESC)
2. Information about net earnings from self-employment, wages, and payments of retirement income maintained by the Social Security Administration (SSA) - "BEERS"
3. Federal retirements and survivors, disability, SSI, and related benefit information available from SSA - "BENDEX" and "SDX"
4. Unearned income information from the Internal Revenue Service (IRS)
5. UIB claim information from MESC.
6. Prisoner Verification System
7. Deceased Matching System (SSA Death Master File)
NOTE: Requests for the aforementioned information shall be made through computer-to-computer techniques. Insofar as practicable, the data will be edited to delete nonessential information being forwarded to regional eligibility staff.
GENERAL RULE - The information noted in FS 888-1 shall be requested from the appropriate agencies about members of all applicant households during the first week of the month following the month in which the application is filed. Information about members of applicant households who cannot provide SSN's at application shall be requested in the month following the month in which the SSN is received.
Information received within the thirty-day application period shall be used to determine eligibility and benefits if it is received for an applicant household which is still pending.
NOTE: Eligibility and benefit determinations shall not be delayed pending receipt of IEVS information.
Information received about applicant households which have already been opened shall be treated the same as information on recipient households (FS 888-4).
GENERAL RULE - The information noted in FS 888-1 shall be requested from the appropriate agencies about members of recipient households as follows:
1. Quarterly, from MESC on wages. Such requests shall include all households which participated in any month of the corresponding quarter.
2. Monthly, from SSA data bases and not later than the second month of the certification period when the requests at application did not establish automatic reporting of changes in SSA data.
3. Annually, from IRS for all current recipients. This request shall be made as soon as practicable after the latest year's data is available from IRS.
4. Weekly, from MESC on UIB benefits for all participating households.
GENERAL RULE - Case action on IEVS information about recipient households must be complete within 45 days of receipt of that information.
NOTE: The 45-day time limit means, in effect, that the Regional Office has thirty days to complete case action, since it will take about two weeks for the Central Office to edit, print, and distribute written instructions to the regions.
Case action includes:
1. review of the information, and comparison of it, to information in the case record.
2. for all new or previously unverified information received, contact with the household and/or the appropriate assets or income source to resolve discrepancies (FS 888-5).
3. when discrepancies warrant, action to begin reduction of benefits or termination of eligibility (advance notice sent).
Appropriate case action and dates shall be noted on the IEVS document and filed in the case record with the exception of documents containing IRS information. All documents generated from IRS source data shall be destroyed once case action is completed. A master file of IRS documents will be maintained at Quality Control. BEERS data contains IRS information and is subject to the same security.
When the case actions substantiate an over-issuance, appropriate actions to initiate claims and/or disqualification proceedings shall be taken. (REMEMBER: Adverse actions based on Federal matches require 30 day advance notice.)
NOTE: The 45-day time limit does not apply to claims and disqualification actions.
When any adverse action is called for and is based upon information from an MESC match, the household shall be sent a written notice at least 12 days prior to taking such adverse action.
The notice shall advise the household that the Department has received information which indicates the need for adverse action and that it has 12 days to contest the decision. The notice shall state that, unless the Department is notified otherwise within 12 days by the household, it will assume that the data provided by the match or obtained through independent verification is correct and the adverse action will be taken.
When any adverse action is called for and is based upon information from BEERS or IRS matches the household shall be sent a written notice at least 30 days prior to taking such adverse action.
GENERAL RULE - Action shall be taken without independent verification based on information obtained through IEVS which is considered verified upon receipt. Such verified information is Social Security and SSI benefit information from SSA and UIB information from the Maine Employment Security Commission.
EXCEPTION: When it appears that the IEVS information about a particular household is questionable, the information shall be considered unverified and must be independently verified.
Prior to taking action to terminate, deny, or reduce benefits based on IEVS information which is considered unverified upon receipt, the information shall be independently verified. Such unverified information is:
1. Unearned income information from IRS.
2. Wage information from the Maine Department of Labor and SSA (BEERS).
3. Prisoner Verification System
4. Deceased Matching System (SSA Death Master File)
5. Questionable information as noted above.
Verification of unverified information shall be obtained by means of contacting the household and/or the appropriate asset or income source.
If the household is contacted it must be in writing. The household must be informed of the information the Department has received, and be requested to respond within 10 days. If the household fails to respond in a timely manner, an appropriate notice of adverse action shall be sent.
The appropriate source may be contacted by the means best suited to the situation.
When the household or appropriate source provides the independent verification the household shall be properly notified of the action to be taken.
When all other sources of income verification are unavailable the amount to be used shall be mutually agreed upon by the client and agency.
Once terminated or denied for failure to respond or refusal to cooperate, the household shall not be determined eligible until it cooperates in the completion of the IEVS review in question.
ADEQUATE NOTICE: Written notice that includes the action the Department intends to take, the reason for the action, the right to request a fair hearing, the person to contact for additional information, the availability of continued benefits and liability for such benefits if found ineligible in hearing decision, and the availability of free legal services.
ADVANCE NOTICE: An adequate notice mailed at least 12 days prior to the effective date of the action except when the action is the result of a computer-to-computer match with BEERS or IRS records. In the latter instance, the notice must be mailed at least 30 days prior to the effective date of the action.
ADVERSE ACTION: Determination to close, suspend or reduce benefits.
ALIEN: An alien is a person who is not a U.S. citizen.
APPLICANT: The individual for whom benefits are requested. (Also see Head of Household.)
APPLICANT HOUSEHOLD: A household which has not participated for at least one full calendar month.
ASSETS, LIQUID: Anything owned in the form of cash or readily convertible to cash.
ASSETS, NON-LIQUID: Anything owned not readily convertible to cash.
ASSISTANCE GROUP (AG): Members of a Household (Section 111-1) receiving the same SNAP benefit type or included in the calculation there-of.
AUTHORIZED REPRESENTATIVE: A non-household member who is authorized, in writing by the household, to make an application, receive the monthly benefits or purchase food with the SNAP benefits for the household.
AUTHORIZED TO RECEIVE: An individual has been determined eligible for benefits and has been notified of this determination, even if the benefits have been authorized but not received, authorized but not accessed, suspended or recouped, or not paid because they are less than a minimum amount.
BENEFIT: Total amount of SNAP allotment a household is authorized to receive.
BOARDER: An individual to whom a household furnishes meals and/or lodging for compensation.
CARD CLONING: The creation and use of a fraudulent EBT card to unlawfully access benefits from SNAP households’ account.
CARD SKIMMING: Card skimming is when devices are illegally installed on ATMs or point-of-sale (POS) terminals to capture card data or record SNAP households’ PINs. Card Skimming may also include fraudulent phone calls or text messaging that mimic official state agency messaging and phishing.
CENTERS FOR THE TREATMENT OF SUBSTANCE USE DISORDERS: Centers, approved by the State, for the treatment of these disorders.
CERTIFICATION PERIOD: Length of time for which eligibility is established.
COLLATERAL CONTACTS: A non-household member who provides information about the household's circumstances.
CORRECTIONAL FACILITY: Any facility that falls under the jurisdiction of the Department of Corrections (DOC) for the purpose of detaining (for 24 hours or more) and/or rehabilitating individuals convicted of a crime or awaiting trial, including those licensed and overseen by DOC, but operated by a county or other entity.
DATE OF APPLICATION:
1. Unless otherwise specified below in 2 and 3, the date of application is the day an application containing the applicant's name and address, signed by either a responsible household member or an authorized representative, is received by the Department or the date the Department receives the telephonic signature.
2. For a resident of a public institution jointly applying for SSI and SNAP benefits prior to leaving the institution, the date of application is the date of release from the institution.
3. For a Maine resident in a state or county correctional facility within Maine, applying for SNAP within 30 days prior to their anticipated release date, and not joining an existing SNAP Household (Section 111-1) upon release, the date of application is the date of release from the facility.
DEPENDENT: A person who relies on another for support and/or care.
DISABLED: (See Individual with a Disability)
DOCUMENTATION: Information, in writing or electronic media, which substantiates the individual’s assertion or Department’s eligibility decision.
DRUG OR ALCOHOL TREATMENT CENTERS: See centers for the treatment of substance use disorders.
DUPLICATE PARTICIPATION: Receiving SNAP benefits in more than one household during the same month.
ELDERLY: Being at least 60 years old.
ELDERLY OR DISABLED: A person who meets either the definition of Elderly or an Individual with a Disability.
ELECTRONIC BENEFIT TRANSFER (EBT) CARD: A debit card used by the SNAP benefit recipient to access benefits.
ELIGIBILITY REVIEW: Periodic redetermination of eligibility or ineligibility and benefit level.
EXECUTIVE OFFICE FOR IMMIGRATION REVIEW (EOIR): Conducts immigration court proceedings, appellate reviews and administrative hearings.
EXPEDITED SERVICE: Processing an application in such time as to assure access to the benefit by the fifth calendar day following the date of application.
FLEEING FELON: An individual for whom a federal, state, or local law enforcement officer acting in their official capacity presents an outstanding felony arrest warrant that conforms to one of the following National Crime Information Center Uniform Offense Classification Codes, to the Department to obtain information on the location of and other information about the individual named in the warrant: (A) Escape (4901); (B) Flight to Avoid (prosecution, confinement, etc.) (4902); or (C) Flight-Escape (4999).
FOOD AND NUTRITION SERVICES (FNS): The Division of the Department of Agriculture that administers the Supplemental Nutrition Assistance Program (SNAP).
FOOD DISTRIBUTION PROGRAM ON INDIAN RESERVATIONS (FDPIR): The program administered by FNS and locally by either Indian Tribal Organizations or an agency of a State government. Dual participation in SNAP and FDPIR is prohibited.
Food Supplement Program (FS): The name by which SNAP benefits within the State of Maine were known prior to July 1, 2021.
FOSTER CARE: Children in the care and custody of the State consistent with 45 C.F.R. § 1305.
GENERAL ASSISTANCE: Cash or another form of assistance financed by State or local funds as part of a program to cover living expenses or other basic needs.
GOOD CAUSE: Valid reasons for noncompliance with certain program requirements.
HEAD OF HOUSEHOLD: That responsible adult household member selected by all adult members of the household. (See Section 111-1 for exception to this definition.)
HIGHER EDUCATION ACT (TITLE IV): A Federal statute establishing financial assistance to students in post-secondary education. Some examples are: PELL Grants, SEOG, Guaranteed Student Loans, and Work Study.
HOMELESSNESS: Lacking a fixed and regular nighttime residence or having a primary nighttime residence of:
1. a supervised shelter designed to provide temporary accommodations;
2. a halfway house or similar institution that provides temporary residence for individuals intended to be institutionalized;
3. a temporary accommodation in the residence of another for not more than 90 days; or
4. a place not designed for regular sleeping accommodation for human beings.
"Homeless" does not describe any individual imprisoned or detained pursuant to a State law.
IMMIGRATION COURT: Is the primary function of the Executive Office for Immigration Review (EOIR) within the United States Department of Justice (DOJ) under the delegated authority from the United States Attorney General.
INDIVIDUAL WITH (or who has) A DISABILITY: A household member who—
1. receives disability payments under Social Security or SSI;
2. is a veteran with a non-service connected disability pension;
3. is a veteran with a service connected disability which is rated or paid as total;
4. is a surviving spouse of a veteran and has been determined by VA to be house-bound or in need of aid-and-attendance (A&A);
5. is a surviving child of a veteran and is considered by VA to be permanently incapable of self-support;
6. is a surviving spouse or child of a veteran and is receiving, or approved to receive, VA compensation or pension payments, and would be disabled according to SSA standards;
7. is a recipient of a federal, state, or local public disability pension;
8. is a recipient of railroad retirement disability; or
9. is a recipient of SSI-related Medicaid.
Verification of the above is required.
INITIAL MONTH: The first month for which a benefit is issued. For households which previously participated it is the first month following at least one month of non-participation and in the case of migrant farm worker households, 30 days of non-participation.
LIVE-IN ATTENDANT: An individual, usually paid, who is needed for medical, housekeeping or child care reasons. They will not be considered household members for SNAP.
LOW-INCOME HOME ENERGY ASSISTANCE PROGRAM (LIHEAP) or (HEAP): A Federal program, authorized under the Low-Income Home Energy Assistance Act of 1981 (Title XXVI of the Omnibus Budget Reconciliation Act of 1981, P.L. 97-35), that provides help with winter energy bills for income-eligible persons. Payments are usually made directly to local utility companies or vendors.
MASS CHANGES: Certain changes imposed by the Federal or State government which may affect the entire caseload or significant portions thereof. Changes may include such items as annual adjustments to income standards, change in deductions, or cost of living adjustments to Temporary Assistance to Needy Families (TANF).
NONCITIZEN: A person residing in the United States who is not a U.S. citizen.
OVERPAYMENT: When a household receives SNAP benefits for which they are not eligible.
PHISHING: Is a fraudulent scheme typically carried out through unsolicited email and/or websites that pose as legitimate sites and lure unsuspecting victims to provide personal financial information. This act results in the collection of information not an item such as an EBT card.
Public Institution: A government operated facility in which people live and receive care typically in a confined setting and often without individual consent.
QUESTIONABLE INFORMATION:
(a) The individual is an established SNAP Participant and in the past 60 months of participation has not reported, over reported, or under reported circumstances such as the start or end of employment, wages, income, assets or expenses;
(b) The information is inconsistent with publicly available information or information that has been reported to the Department such as information about others residing at the location or reports of the individual having additional income sources or amounts;
(c) The type of information is one that contributes to common error trends such as shared rent expenses, reporting a rent expense that is inconsistent with those known in the geographical area, or income or tax expenses are reported as unchanged for 12 months or more; and
(d) Instances where previously provided documentation appears to be outdated, inaccurate, or potentially falsified.
REFUSAL TO COOPERATE: When a household has the ability to cooperate, but clearly demonstrates that they will not take required action, even though they are able to do so.
RENEWAL FORM: A notice provided by the Department to the household that must be completed and returned to the Department as part of the required Annual Eligibility Review.
RESTORATION OF LOST BENEFITS: When a household is granted too few SNAP benefits and the error is caused by the Department, action is taken to restore lost benefits.
Roomer: An individual renting living space in the household’s primary residence. Roomers are distinguished from other renters because they share kitchen facilities with the lessor. Roomers are distinguished from boarders because they do not purchase and prepare the majority of meals with the lessor.
SEPARATE HOUSEHOLD: Individuals sharing common living quarters, but who customarily purchase and prepare meals apart from each other.
SHELTER FOR BATTERED PERSONS: A place of temporary protection and support for persons escaping domestic violence and intimate partner violence of all forms.
SHELTER FOR INDIVIDUALS EXPERIENCING HOMELESSNESS: A building set up to provide for the needs of individuals experiencing homelessness; often including shelter, food, sanitation, and other forms of support.
SIX-MONTH REPORT: An interim report required for some households in the middle of the certification period. Information reported on the six-month report must reflect current household status.
SPONSORED NONCITIZENS: A legal noncitizen who is lawfully present and entered the country based on an "Affidavit of Support" (USCIS Form I-134) or similar written agreement executed by a sponsor on behalf of the noncitizen.
SUBSTANCE ABUSE TREATMENT CENTERS: See centers for the treatment of substance use disorders.
THRIFTY FOOD PLAN: The maximum monthly benefit a household can receive. It is based on household size.
TRAFFICKING:
(1) The buying, selling, stealing, or otherwise effecting an exchange of SNAP benefits issued and accessed via Electronic Benefit Transfer (EBT) cards, card numbers and personal identification numbers (PINs), or by manual voucher and signature, for cash or consideration other than eligible food, either directly, indirectly, in complicity or collusion with others, or acting alone;
(2) The exchange of firearms, ammunition, explosives, or controlled substances, as defined in section 802 of title 21, United States Code, for SNAP benefits;
(3) Purchasing a product with SNAP benefits that has a container requiring a return deposit with the intent of obtaining cash by discarding the product and returning the container for the deposit amount, intentionally discarding the product, and intentionally returning the container for the deposit amount;
(4) Purchasing a product with SNAP benefits with the intent of obtaining cash or consideration other than eligible food by reselling the product, and subsequently intentionally reselling the product purchased with SNAP benefits in exchange for cash or consideration other than eligible food;
(5) Intentionally purchasing products originally purchased with SNAP benefits in exchange for cash or consideration other than eligible food; or
(6) Attempting to buy, sell, steal or otherwise affect an exchange of SNAP benefits issued and accessed via Electronic Benefit Transfer (EBT) cards, card numbers and personal identification numbers (PINs), or by manual voucher and signature, for cash or consideration other than eligible food, either directly, indirectly, in complicity or collusion with others, or acting alone. (7 C.F.R. §271.2).
UNITED STATES DEPARTMENT OF JUSTICE (DOJ): A federal executive office responsible for the enforcement of federal law.
UNCLEAR INFORMATION: Information provided to the Department that may convey more than one meaning or for which no single meaning can reasonably be ascribed and depending on the actual meaning could result in a different eligibility decision or benefit amount.
VENDOR PAYMENT: A money payment made on behalf of the household by a third party.
VETERAN: As defined in Section 5126(f)(13)(F) of the James M. Inhofe National Defense Authorization Act of 2023, means an individual who served in the United States Armed Forces (such as Army, Marine Corps, Navy, Air Force, Space Force, Coast Guard, and National Guard), including an individual who served in a reserve component of the Armed Forces, and who was discharged or released therefrom, regardless of the conditions of such discharge or release.
Effective October 1, 2023 through September 30, 2024, a resident of the following Maine geographic areas (cities, towns, plantations, unorganized territories, townships and reservations) is exempt from ABAWD work requirements, per a federal geographic waiver approved pursuant to 7 C.F.R. § 273.24(f)(2) and section 6(o) of the Food and Nutrition Act of 2008:
Addison
Alexander
Allagash
Amity
Andover
Anson
Ashland
Athens
Atkinson
Aurora
Avon
Baileyville
Bancroft
Baring
Beals
Beaver Cove
Bethel
Bingham
Blaine
Blanchard
Boothbay Harbor
Bowerbank
Bradford
Bridgewater
Brighton
Brownville
Burlington
Byron
Calais
Cambridge
Canaan
Canton
Caratunk
Caribou
Carroll
Carthage
Cary
Castle Hill
Caswell
Central Aroostook *
Central Hancock *
Chapman
Charleston
Charlotte
Cherryfield
Chester
Codyville
Columbia
Columbia Falls
Connor
Cooper
Coplin
Corinna
Corinth
Cornville
Crawford
Crystal
Cutler
Cyr
Dallas
Danforth
Deblois
Dennistown
Dennysville
Detroit
Dixfield
Dixmont
Drew
Dyer Brook
Eagle Lake
East Central Franklin *
East Central Penobscot *
East Central Washington *
East Hancock *
East Machias *
East Millinocket
Eastbrook
Easton
Eastport
Embden
Etna
Eustis
Fort Fairfield
Fort Kent
Franklin
Frenchville
Garfield
Garland
Gilead
Glenwood
Gouldsboro
Grand Isle
Grand Lake Stream
Great Pond
Greenwood
Hamlin
Hammond
Hanover
Harmony
Harrington
Hartland
Haynesville
Hersey
Highland
Hodgdon
Houlton
Indian Township
Island Falls
Jackman
Jackson
Jonesboro
Jonesport
Kingfield
Kingman
Kingsbury
Lagrange
Lake View
Lakeville
Lee
Limestone
Lincoln
Lincoln Plantation
Linneus
Littleton
Livermore
Livermore Falls
Lowell
Lubec
Ludlow
Machias
Machiasport
Macwahoc
Madawaska
Madison
Magalloway
Mapleton
Mariaville
Mars Hill
Marshfield
Masardis
Mattawamkeag
Maxfield
Meddybemps
Medway
Mercer
Merrill
Mexico
Milbridge
Millinocket
Milo
Milton
Monticello
Moose River
Moro
Moscow
Mount Chase
Nashville
New Canada
New Limerick
New Portland
New Sweden
New Vineyard
Newry
Norridgewock
North Franklin *
North Oxford *
North Penobscot *
North Washington *
Northeast Piscataquis *
Northeast Somerset *
Northfield
Northwest Aroostook *
Northwest Hancock *
Northwest Piscataquis *
Northwest Somerset *
Oakfield
Orient
Osborn
Oxbow
Palmyra
Passadumkeag
Patten
Pembroke
Perham
Perry
Peru
Phillips
Pittsfield
Pleasant Point
Pleasant Ridge
Plymouth
Portage Lake
Prentiss
Presque Isle
Princeton
Reed
Ripley
Robbinston
Roque Bluffs
Roxbury
Rumford
Sangerville
Sebec
Seboeis
Seboomook Lake
Sherman
Shirley
Skowhegan
Smithfield
Smyrna
Solon
South Aroostook *
South Franklin *
Southeast Piscataquis *
Southport
Southwest Harbor
Springfield
Square Lake
St. Agatha
St. Albans
St. Francis
St. John
Stacyville
Starks
Steuben
Stockholm
Stoneham
Strong
Sullivan
Talmadge
The Forks
Topsfield
Tremont
Troy
Twombly Ridge
Upton
Van Buren
Vanceboro
Wade
Waite
Wallagrass
Washburn
Webster
Weld
Wellington
Wesley
West Forks
Westfield
Westmanland
Weston
Whiting
Whitney
Whitneyville
Willimantic
Winn
Winter Harbor
Winterville
Woodland
Woodstock
Woodville
Effective October 1, 2024 through September 30, 2025, a resident of the following Maine geographic areas (cities, towns, plantations, unorganized territories, townships and reservations) is exempt from ABAWD work requirements, per a federal geographic waiver approved pursuant to 7 C.F.R. § 273.24(f)(2) and section 6(o) of the Food and Nutrition Act of 2008:
Abbott
Addison
Alexander
Allagash
Amity
Anson
Ashland
Athens
Aurora
Avon
Baileyville
Bancroft
Baring
Bingham
Blaine
Blanchard
Bowerbank
Bridgewater
Brighton
Brownville
Burlington
Calais
Cambridge
Caratunk
Caribou
Carroll
Carthage
Cary
Castle Hill
Caswell
Central Aroostook *
Central Hancock *
Charlotte
Cherryfield
Chester
Codyville
Columbia
Columbia Falls
Connor
Cooper
Coplin
Corinna
Crawford
Crystal
Cutler
Cyr
Dallas
Danforth
Deblois
Dennistown
Detroit
Dexter
Drew
Dyer
Eagle Lake
East Central Franklin *
East Central Penobscot *
East Hancock *
East Millinocket
Easton
Eastport
Edinburg
Embden
Eustis
Fort Fairfield
Fort Kent
Franklin
Frenchville
Garfield
Garland
Glenwood
Gouldsboro
Grand Isle
Grand Lake Stream
Great Pond
Hamlin
Hammond
Hanover
Harmony
Harrington
Hartland
Haynesville
Hersey
Highland
Hodgdon
Houlton
Indian Island
Indian Township
Island Falls
Jackman
Jackson
Jonesboro
Kingfield
Kingman
Kingsbury
Lagrange
Lake View
Lakeville
Lee
Limestone
Lincoln
Linneus
Littleton
Lowell
Ludlow
Machias
Macwahoc
Mars Hill
Masardis
Matinicus
Mattawamkeag
Maxfield
Meddybemps
Medway
Mercer
Merrill
Mexico
Milbridge
Millinocket
Milo
Milton
Monson
Monticello
Moose River
Moro
Moscow
Mount Chase
Nashville
New Canada
New Limerick
New Portland
New Sweden
North Franklin *
North Oxford *
North Penobscot *
North Washington *
Northeast Piscataquis *
Northeast Somerset *
Northwest Hancock *
Northwest Piscataquis *
Northwest Somerset *
Oakfield
Ogunquit
Orient
Osborn
Palmyra
Parkman
Passadumkeag
Patten
Pembroke
Perham
Perry
Peru
Phillips
Pittsfield
Pleasant Point
Pleasant Ridge
Plymouth
Portage Lake
Prentiss
Princeton
Rangeley
Reed
Ripley
Robbinston
Roxbury
Sangerville
Sebec
Seboeis
Sherman
Smithfield
Smyrna
Solon
South Aroostook *
South Franklin *
Southeast Piscataquis *
Springfield
Square Lake
St. Albans
St. Francis
St. John
Stacyville
Starks
Steuben
Stockholm
Sullivan
Sweden
Talmadge
The Forks
Topsfield
Tremont
Troy
Twombly Ridge
Van Buren
Vanceboro
Wade
Waite
Wallagrass
Washburn
Webster
Weld
Wellington
West Forks
Westfield
Westmanland
Weston
Whitney
Whitneyville
Willimantic
Winn
Winter Harbor
Winterville
Woodville
*Some of the unorganized territories listed above consist of the following subdivisions or aliases:
Central Aroostook
C R2
Cox Patent
D R2
Dudley
E R2
Scopan
St. Croix
T7 R5
T8 R3 and 5
T9 R3-5
T10 R3
T11 R4
Webbstown
Central Hancock
Fletcher’s Landing
East Central Franklin
Freeman
Madrid
Mount Abram
Reddington
East Central Penobscot
Grand Falls
Greenfield
Summit
East Central Washington
Berry
Cathance
Edmonds
Marion
T19 ED
Trescott
East Hancock
16 MD
22 MD
28 MD
34 MD
35 MD
39 MD
40 MD
41 MD
3 ND
Oquiton
7 SD
9 SD
10 SD
North Franklin
Alder Stream
Beattie
Chains of Pond
Davis
Gorham Gore
Jim Pond
Kibby
Lang
Lowell-town
Massachusetts Gore
Merrill Strip
Seven Ponds
Skinner
Stetson-town
Tim Pond
North Oxford
Adamstown
Andover N Surplus
Andover W Surplus
Bowmantown
C Surplus
Grafton
Lower Cupsuptic
Lynchtown
Oxbow
Parkertown
Parmachene
Richardsontown
Riley
North Oxford (cont.)
Township C
Upper Cupsuptic
North Penobscot
AR 7
Davidson
Grindstone
Hopkins Academy Grant (E and W)
Indian Purchase 3 and 4
Long A
Mattamiscontis
T1 R6 and 8
T2 R7-9
T3 R7-9
4 R7 and 8
T5 R7 and 8
T7 R6-8
T8 R6-8
Veazie Gore
North Washington
Big Lake
Brookton
Centerville
Day Block
Devereaux
Dyer
Forest
Forest City
Fowler
Greenlaw Chopping
Indian Twp
Kilgore
Kossuth
Lambert Lake
Sackom
T6 ND
T6 R1
T8 R3 and 4
T18 MD
T19 MD
T24 MD
T25 MD
T26 ED
T30 MD
T36 MD
T42 MD
T43 MD
T47 MD
Northeast Piscataquis
AR 10 and 11
Bernard
Bowdoin College Grant (E and W)
Ebeemee
Elliotsville
French Town
Katahdin Iron Works
Lily Bay (partial)
Mount Katahdin
Nesourdhunk
Shawtown
Soper Mtn. (partial)
Rainbow
T1 R9-12 part of 13
T3 R10 and 11 part of 12
T4 R9-11 part of 12
T4 R 9 N.W.P.
T5 R9 and 11 part of 12
T6 R10 and 11
T7 R9-11 part of 12
T8 R9-11
T9 R9-11 part of 12
T10 R9-11 part of 12 and 13
Trout Brook
Williamsburg
Northeast Somerset
Bald Mtn.
Bradstreet
Chase
Indian Stream
E. Moxie
Long Pond
Mayfield
Misery
Misery Gore
Moxie Gore
Parlin Pond
Rockwood Strip (Rockwood Twp)
Sandwich Acadamy Grant
Saplin
Squaretown
T1 R6
T2 R6
Taunton & Raynham
Northwest Aroostook
Clayton Lake
T9 R7 and 8
T10 R6-8
T11 R7-13 and 15-17
T12 R7-17
T13 R7-16
T14 R 6-16
T15 R8-15
T16 R8, 9 and 12-14
T17 R12-14
T18 R10-13
T19 R 11 and 12
T20 R 11 and 12
Northwest Hancock
32 MD
Northwest Piscataquis
Big Moose
Chesuncook
Day’s Academy Grant
E. Middlesex Canal
Eagle Lake
Kineo
Lily Bay (partial)
Moosehead Jct.
NE Carry
Soper Mtn. (partial)
Spencer Bay
T1 part of R13
T2 R13 and 14
T3 R13 and 14 part of 12
T4 R13-15 part of 12
T5 R14 and 15 part of 12
T6 R12-15
T7 R13-15 part of 12
T8 R14 and 15T9 R13-15 part of 12
T10 R14 and 15 part of 12 and 13
Northwest Somerset
Appleton
Attean
Bigelow
Bowtown
Carrying Place
Dead River
Flagstaff
Forsyth
Hobstown
Holeb
King & Bartlett
Lower Blanchard
T1 R3
T2 R4
T3 R4 and 5
T5 R6 and7
Upper Blanchard
South Aroostook
A R2
Benedicta
Molunkus
N. Yarmouth Academy Grant
Silver Ridge 1 R5
T2 R4
T3 R2-4
T4 R3
Upper Molunkus
South Franklin
Perkins
Southeast Piscataquis
Orneville
NOTE: These tables are extended to meet the needs of certain categorically eligible households. Therefore, the amounts shown on the tables are higher than the net income limits for some household sizes. Households must have incomes below the appropriate income limits unless exempt per Section 444-8.
* Maximum Gross and Net Monthly Income figures are not used for computing the benefit amount. They are included as a reference for determining the household’s eligibility.
Chart 1
100% of Federal Poverty Level (FPL) monthly income
(Net income test)
Household Size | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | Each Additional Member FFY 2023 10/1/22 - 9/30/23 | $1,133 | $1,526 | $1,920 | $2,313 | $2,706 | $3,100 | $3,493 | $3,886 | $394 FFY 2024 10/1/23 - 9/30/24 | $1,215 | $1,644 | $2,072 | $2,500 | $2,929 | $3,357 | $3,785 | $4,214 | $429 FFY 2025 10/1/24 - 9/30/25 | $1,255 | $1,704 | $2,152 | $2,600 | $3,049 | $3,497 | $3,945 | $4,394 | $449 FFY 2026 10/1/25 - 9/30/26 | $1,305 | $1,763 | $2,221 | $2,680 | $3,138 | $3,596 | $4,055 | $4,513 | $459 FFY 2027 10/1/26 - | $1,330 | $1,803 | $2,277 | $2,750 | $3,223 | $3,697 | $4,170 | $4,643 | $473
Chart 2
130% of Federal Poverty Level (FPL) monthly income
(Non-categorical gross income test)
Household Size | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | Each Additional Member FFY 2023 10/1/22 - 9/30/23 | $1,473 | $1,984 | $2,495 | $3,007 | $3,518 | $4,029 | $4,541 | $5,052 | $512 FFY 2024 10/1/23 - 9/30/24 | $1,580 | $2,137 | $2,694 | $3,250 | $3,807 | $4,364 | $4,921 | $5,478 | $557 FFY 2025 10/1/24 - 9/30/25 | $1,632 | $2,215 | $2,798 | $3,380 | $3,963 | $4,546 | $5,129 | $5,712 | $583 FFY 2026 10/1/25 - 9/30/26 | $1,696 | $2,292 | $2,888 | $3,483 | $4,079 | $4,675 | $5,271 | $5,876 | $596 FFY 2027 10/1/26 - | $1,729 | $2,344 | $2,960 | $3,575 | $4,190 | $4,806 | $5,421 | $6,036 | $615
Chart 3
165% of Federal Poverty Level (FPL) monthly income
(Gross income test for those purchasing and preparing meals with individuals who are elderly and have a disability and their spouses to qualify as a separate household (Section 111-1(2)(c))
Household Size | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | Each Additional Member FFY 2023 10/1/22 - 9/30/23 | $1,869 | $2,518 | $3,167 | $3,816 | $4,465 | $5,114 | $5,763 | $6,412 | $649 FFY 2024 10/1/23 - 9/30/24 | $2,005 | $2,712 | $3,419 | $4,125 | $4,832 | $5,539 | $6,246 | $6,952 | $707 FFY 2025 10/1/24 - 9/30/25 | $2,071 | $2,811 | $3,551 | $4,290 | $5,030 | $5,770 | $6,510 | $7,249 | $740 FFY 2026 10/1/25 - 9/30/26 | $2,152 | $2,909 | $3,665 | $4,421 | $5,177 | $5,934 | $6,690 | $7,446 | $757 FFY 2027 10/1/26 - | $2,195 | $2,976 | $3,757 | $4,538 | $5,319 | $6,100 | $6,881 | $7,662 | $781
Chart 4
185% or 200% of Federal Poverty Level (FPL) monthly income
(Gross income test for narrow and broad-based categorical eligibility)
Household Size | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | Each Additional Member Calendar Year 2022 1/12/22 - 6/30/22 | $2,096 | $2,823 | $3,551 | $4,279 | $5,006 | $5,734 | $6,462 | $7,189 | $728 Calendar Year 2022 7/1/22 - 1/18/23 | $2,265 | $3,052 | $3,839 | $4,625 | $5,412 | $6,199 | $6,985 | $7,772 | $787 Calendar Year 2023 1/19/23 - 1/10/24 | $2,430 | $3,287 | $4,144 | $5,000 | $5,857 | $6,714 | $7,570 | $8,427 | $857 Calendar Year 2024 1/11/24 - 1/16/25 | $2,510 | $3,407 | $4,304 | $5,200 | $6,097 | $6,994 | $7,890 | $8,787 | $897 Calendar Year 2025 1/17/25 - 1/12/26 | $2,609 | $3,525 | $4,442 | $5,359 | $6,275 | $7,192 | $8,109 | $9,025 | $917 Calendar Year 2026 1/13/26 - | $2,660 | $3,607 | $4,553 | $5,500 | $6,447 | $7,393 | $8,340 | $9,287 | $947
Chart 5
Thrifty Food Plan monthly budget
(Maximum monthly SNAP benefit)
Household Size | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | Each Additional Member FFY 2021 1/1/21 – 9/30/21 | $234 | $430 | $616 | $782 | $929 | $1,114 | $1,232 | $1,408 | $176 FFY 2022 10/1/21 – 9/30/22 | $250 | $459 | $658 | $835 | $992 | $1,190 | $1,316 | $1,504 | $188 FFY 2023 10/1/22 – 9/30/23 | $281 | $516 | $740 | $939 | $1,116 | $1,339 | $1,480 | $1,691 | $211 FFY 2024 10/1/23 – 9/30/24 | $291 | $535 | $766 | $973 | $1,155 | $1,386 | $1,532 | $1,751 | $219 FFY 2025 10/1/24 – 9/30/25 | $292 | $536 | $768 | $975 | $1,158 | $1,390 | $1,536 | $1,756 | $220 FFY 2026 10/1/25 - | $298 | $546 | $785 | $994 | $1,183 | $1,421 | $1,571 | $1,789 | $218
Chart 6
Minimum benefit for categorically eligible households of 1 or 2 members.
FFY 2022 10/1/21 - 09/30/2 2 | $20 FFY 2023 - 2025 10/1/22 - 9/30/25 | $23 FFY 2026 10/1/25 - | $24
Chart 7
Standard Deduction
Household Size | 1 to 3 | 4 | 5 | 6 or more FFY 2022 10/1/21 – 9/30/22 | $177 | $184 | $215 | $246 FFY 2023 10/1/22 – 9/30/23 | $193 | $193 | $225 | $258 FFY 2024 10/1/23 – 9/30/24 | $198 | $208 | $244 | $279 FFY 2025 10/1/24 – 9/30/25 | $204 | $217 | $254 | $291 FFY 2026 10/1/25 - | $209 | $233 | $261 | $299
Chart 8
Shelter deductions and allowances
Maximum Shelter Deduction | Full Standard Utility Allowance (FSUA) | Non-Heat Utility Allowance (NHUA) | Phone Only Utility Allowance ( PhUA ) | Homeless Shelter Deduction FFY 2022 10/1/21 - 2/28/22 | $597 | $844 | $285 | $49 | $159.73 FFY 2022 3/1/22 - 9/30/22 | $597 | $886 | $299 | $51 | $159.73 FFY 2023 10/1/22 - 9/30/23 | $624 | $1,075 | $363 | $62 | $166.81 FFY 2024 10/1/23 - 9/30/24 | $672 | $ 1,011 | $ 341 | $ 58 | $179.66 FFY 2025 10/1/24 - 9/30/25 | $712 | $1,047 | $353 | $60 | $190.30 FFY 2026 10/1/25 - | $744 | $1,096 | $598 | $114 | $198.99
Chart 9
Asset Limits
Certain Broad Based Categorical Households | Non-Categorical Households with a Member who is Elderly or has a Disability | Non-Categorical Households with no Members who are Elderly or have a Disability FFY 2022 10/1/21 - 12/31/21 | $5,000 | $3,750 | $2,500 Calendar Year 2022 1/1/22 - 9/30/22 | No Limit | $3,750 | $2,500 FFY 2023 - 2024 10/1/22 - 9/30/24 | No Limit | $4,250 | $2,750 FFY 2025 10/1/24 - | No Limit | $4,500 | $3,000
STATUTORY AUTHORITY: 22 MRS §§ 42(1), 3104(13), and 3104-A
CORRECTIONS:
April 1, 2020
March 1, 2023
AMENDED:
October 21, 2013 – filing 2013-248
January 11, 2016 – filing 2016-001
December 19, 2017 – filing 2017-197
December 25, 2019 – filing 2019-257
July 1, 2020 – filing 2020-137
September 1, 2020 – filing 2020-198
October 1, 2020 – filing 2020-213 (EMERGENCY)
February 1, 2021 – filing 2021-032 (EMERGENCY)
May 1, 2021 – filing 2021-082
May 19, 2021 – filing 2021-093
June 1, 2021 – filing 2021-118
August 2, 2021 – filing 2021-147
August 15, 2021 – filing 2021-155
October 1, 2021 – filing 2021-156
October 1, 2021 – filing 2021-199
December 30, 2021 – filing 2021-256
March 1, 2022 – filing 2022-031
May 30, 2022 – filing 2022-086
March 1, 2023 – filing 2023-026
September 1, 2023 – filing 2023-136
November 26, 2023 – filing 2023-238
December 3, 2023 – filing 2023-242
January 28, 2024 – filing 2024-013
May 14, 2024 – filing 2024-117
August 18, 2024 – filing 2024-186
November 17, 2024 – filing 2024-257
November 17, 2024 – filing 2024-258
December 17, 2024 – filing 2024-272
April 8, 2025 – filing 2025-082
July 15, 2025 – filing 2025-143
September 16, 2025 – filing 2025-177 (EMERGENCY)
September 18, 2025 – filing 2025-183 (EMERGENCY)
APAO ACCESSIBILITY CHECK: December 9, 2025 (no issues detected)
AMENDED:
December 14, 2025 – filing 2025-241
December 14, 2025 – filing 2025-242
APAO ACCESSIBILITY CHECK (Word): March 31, 2026
April 5, 2026 – filing 2026-075
NONSUBSTANTIVE CORRECTIONS:
April 6, 2026
APAO ACCESSIBILITY CHECK (Word):
May 12, 2026
AMENDED:
May 17, 2026 – filing 2026-115
June 28, 2026 – filing 2026-133
NONSUBSTANTIVE CORRECTION (addition of the adoption filing number to the first page of the rule):
June 26, 2026
10-144
DEPARTMENT OF HEALTH AND HUMAN SERVICES
OFFICE FOR FAMILY INDEPENDENCE
Chapter 331
MAINE PUBLIC ASSISTANCE MANUAL
(TANF – TEMPORARY ASSISTANCE FOR NEEDY FAMILIES)
[Effective 11/30/2025 – filing 2025-231]
Introduction and General Definitions
Overview of Programs 1
General Definitions 2
Chapter I - Eligibility Process
Legal Basis 1
General Rule 1
Program Requirements 1
Confidentiality 1
Application Process 3
Minimum Requirements 3
The Interview 4
The Family Contract 5
Orientation 5
Verification and Documentation 6
Applicant Notification 8
Time and Processing Standards 8
Non-Payment Situations 10
Concurrent Assistance 10
Penalties for Convictions 11
Redetermination Process 11
Recipient Responsibilities 11
Department Responsibilities 12
Quality Control review 12
Change Process 12
Timely Reporting 12
Treatment of Changes 13
Timely/Adequate Notices 13
Timely Notices 13
Adequate Notices 14
Sixty (60) Month Benefit Limit 14
Exemptions from the Time Limit 14
Benefits Which Count Toward the Limit 15
Provisions for Extensions to the Time Limit 15
Chapter II - Eligibility Requirements (non-financial)
Age 1
Residence 1
Citizenship 1
General Rule 1
Citizens and U.S. Nationals 2
Noncitizens Potentially Eligible for Federally Funded TANF/PaS 8
Noncitizens Potentially Eligible for State Funded TANF/PaS 19
Processing Procedures 24
Social Security Numbers 29
Requirement to Provide Social Security Numbers 29
Penalties for not Providing Social Security Numbers 29
Relationship and Maintenance of Home 29
Child Must be Living with a Specified Relative 29
Relationship 29
Maintenance of a Home 30
Filing Unit 32
Mandatory Inclusion 32
Optional Inclusion 34
Establishment of Paternity and Assignment of Rights to Support 34
Requirement to Cooperate 34
Forwarding Support 34
Penalties for Noncooperation 35
ASPIRE-TANF 36
Participation Requirement 36
Exemptions 37
Sanctions 37
Good Cause 38
Good Cause Procedures 39
Chapter III - Eligibility Requirements (financial)
Assets 1
Types of assets 1
Ownership 1
Accessibility 1
Value 2
Excluded Assets 2
Assets Excluded by Federal Statute 4
Income 5
Types of Income 5
Excluded Income 6
Income Excluded by Federal Statute 8
Chapter IV - Budgeting Process
Prospective Budgeting 1
Definition 1
Income Availability 1
Best Estimate 1
Significant Income Changes 1
Non-Significant Income Changes 1
Income Disregards 1
Application of Disregards 1
Work Related Disregards 2
Step Disregard 2
Other Disregards 3
Deemed Income 3
Individuals whose income is deemed 3
Sanctioned Specified relatives 4
Sponsors of Noncitizens and their Spouses 4
Treatment of Special Income 4
Income of specified relatives and their spouses who are not parents of the dependent child. 4
Self-Employment Income 4
Income from Boarders and Roomers 5
Non-Recurring Lump Sum Income 5
Income of Sponsors of Noncitizens 6
Attributed Tips 7
Child Support Paid by the Non-Custodial Parent 7
Child Support collected by the Department 7
Income Calculation 8
Verification 8
Significant income changes 8
Income Averaging 8
Determine Gross Income 9
Apply Disregards in the following order 9
Income Eligibility Tests 9
Test for Determining Eligibility for Applications 9
Test for Determining Ongoing Eligibility 9
Calculation of Payment 10
Calculate the Basic TANF Grant 10
STEP Disregard Calculation 10
Apply the Correct Grant Amount 10
Special Need Housing Allowance (SNHA) 10
No Benefit Households 11
Rounding 11
Assistance Amount 12
Total Benefits Package 12
Total Benefit 12
Child Care Payment Direct to Provider 12
Chapter V - Transitional Benefits
Transitional Child Care 1
Definition 1
Eligibility Criteria 1
Eligibility Process 2
TCC Benefit Calculation 3
TCC Payment Issuance 4
Reporting Responsibilities 5
Redetermination 5
Termination of Benefits 6
Application for TANF/PA’s 6
Break in Assistance 6
Child Care Providers 6
Overpayments 7
Recovery of Overpayments 7
Transitional Transportation 7
Definition 7
Eligibility Criteria 9
Application Process 10
Payment Calculation 10
Payment 11
Reporting Responsibilities 11
Redetermination 11
Overpayments 12
Recovery of Overpayments 12
Chapter VI - Administrative Procedures
Fair Hearings 1
Types of Payments 8
IEVS 12
Overpayments 15
Intentional Program Violations 17
Administrative Hearings 18
Underpayments 26
Lost, Stolen, Destroyed, or Forged Checks 27
Agency Error/Emergency Situation 28
Electronic Benefit Transfer (EBT) System 30
Chapter VII – Whole Family Economic Security Initiatives
Whole Family Economic Security Initiatives 1
General 1
Organization Qualification 1
Family Eligibility 1
Contract Requirements and Process 1
Chapter VIII - Emergency Assistance
Emergency Assistance 1
Chapter IX - Alternative Aid Assistance Program
Legal Basis 1
General Rule 1
Participants 1
Payment 1
Eligibility Requirements 1
Receipt of Alternative Aid Does Not count as Receipt of TANF 2
Prohibitions Against Duplicate Participation 2
Informing TANF Applicants 2
Chapter X - Parents as Scholars
Legal Basis 1
General Rule 1
Program Requirements 1
Participation Requirements 2
Good Cause 3
Chapter XI - Post Employment Assistance to Working Families
Working Families Supplement Benefit (WSB) 1
Appendix
Table of Percentages for First Month Payment 1
Standard of Need and Maximum Grant Allotments 2-4
Worksheet for Calculating TCC Parent Fees and Subsidy Payments 5-6
Federal Poverty Level 7
TCC Market Cap 7
Relationship 8
On October 1, 1996, the Department of Health and Human Services submitted a State Plan to the Secretary of Health and Human Services to eliminate and replace its Aid for Families with Dependent Children Program with Temporary Assistance for Needy Families (TANF) as authorized by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. The Department refers to its financial assistance programs under this Act as the Temporary Assistance for Needy Families and Parents as Scholars (PaS) programs. These programs provide assistance to families while parents prepare for, accept, and retain employment which supports them. The job preparation program is referred to as ASPIRE-TANF or ASPIRE-PaS.
Federal and State statutes provide the authority for TANF/PaS. Maine statutes place the responsibility for administering these programs with the Maine Department of Health and Human Services (“Department”). Within the Department, the program is administered by the Office for Family Independence (OFI).
The TANF/PaS programs are administered in a manner consistent with the objectives of the programs and respect the rights, privacy and personal dignity of the individual under the United States Constitution, the Social Security Act and the Civil Rights Act of 1964.
(1) The TANF Program is a financial assistance program for needy families with dependent children.
(2) The PaS Program is a student financial aid program based on need limited to 2000 parents who have dependent children. (Chapter X).
Families who are otherwise eligible for the TANF program who seek one-time, short-term assistance to obtain or retain employment may elect Alternative Aid Assistance instead of TANF. Alternative Aid Assistance is described in Chapter IX.
In addition to the basic TANF/PaS programs and the one-time, short-term Alternative Aid Assistance program, the Department administers a limited program of Emergency Assistance (EA) described in Chapter VIII.
In accordance with the Americans with Disabilities Act, no qualified individual with a disability shall, by reason of such disability, be excluded from participation or be denied the benefits of the services, programs or activities of the Maine Department of Health and Human Services, or be subjected to discrimination by the Maine Department of Health and Human Services.
Additionally, applicants and recipients are assured confidentiality, equitable and courteous treatment in a trauma informed and linguistically appropriate manner. Applicants and recipients may appeal decisions and have fair hearings should they disagree with any action taken affecting their benefit.
Furthermore, the Department provides interpreters at no cost to non-English speaking individuals applying for or participating in Department Programs.
Assistance may not be given to a family that includes an adult who has received assistance for 60 or more months, whether or not consecutive, under any TANF cash assistance program, including PaS. The Department shall disregard any month for which assistance was provided with respect to the individual and during which the individual was:
(1) a minor child and not the head of a household or married to the head of a household,
(2) an adult who lived in Indian country during a month when at least 50% of the adults living on the reservation were unemployed, or
(3) in a family receiving the enhanced earned income disregard.
Extension of benefits beyond 60 months is explained in Chapter I, Time Limit.
A
Acceptable Medical or Mental Health Source - The following are acceptable medical sources:
Licensed physicians;
Physician’s assistants;
Nurse Practitioners;
Licensed osteopaths;
Licensed or certified psychologists;
Licensed podiatrists for impairments of the foot and/or ankle;
Qualified speech-language pathologists for speech and language impairments only;
Licensed optometrist for the measurement of visual acuity and visual fields; and
Persons authorized to provide copies of the summaries of medical records of medical institutions.
ADA - Americans with Disabilities Act of 1990, P.L. 101-336. 104 Stat. 328 (1990).
Additional Support for People in Retraining and Employment - ASPIRE - The employment and training program for TANF/PaS recipients.
Adequate Notice - Written notification provided to the individual no later than the date of intended action or the date benefits would have been received. Adequate notice includes a statement of the action the agency intends to take, the reason for the action, the agency policy and state and federal regulations supporting the action, the right to request a fair hearing, the person to contact for additional information, the availability of continued benefits and liability for such benefits if found ineligible in the hearing decision.
Administrative Error - An action or lack of action by the Department resulting in the underpayment or overpayment of an individual’s level of benefit or resulting in an incorrect determination of eligibility or ineligibility.
Adverse Action - Decision intended to discontinue, terminate, disqualify/sanction, or reduce assistance, or to impose such conditions as protective payments or participation requirements.
Affordable child care - Affordable child care arrangements are those for which the participant incurs minimal (TCC parent fee) or no cost or is reimbursed by another program such as ASPIRE or through a deduction for child care from income by the TANF program or by any combination of these methods.
Allocation - A deduction from one person’s income for the maintenance needs of others.
AmeriCorps - A network of national service programs that aim to improve lives and foster civic engagement. The Corporation for National and Community Service administers several AmeriCorps programs, which include AmeriCorps State and National, AmeriCorps VISTA, and AmeriCorps National Civilian Community Corps (NCCC).
Annuity - A contract under which a sum is paid yearly or at other specific times in return for the prior payment of a fixed sum.
Anticipated Change - A change that is expected to occur in the future.
Applicant - A person who has submitted a request for assistance for whom no decision has been made regarding eligibility, and whose application has not been acted upon or voluntarily withdrawn.
Application - A request for assistance made by submitting a signed and dated application document (including electronic format) including a name and address.
Application Date - The date an application is received by the Department.
ASPIRE Support Services - Supports paid for by the Department for such services as child care, transportation, eye and dental care. These supports enable the participant to comply with their signed Family Contract Amendment.
Assets - Cash, other liquid resources or real or personal property.
Assignment of Rights to Support - A process whereby the right to receive and collect an individual’s child support is transferred to the Department for the purpose of reimbursing TANF financial assistance.
Assistance Group (AG) – A set of individuals composed of the eligible child(ren) and the eligible specified relative(s) who are living together, with or without benefit of a dwelling, whose needs, income, and resources are considered and combined when determining eligibility and the amount of financial assistance.
Authorized Representative - A person acting for an applicant/client through the individual's written authorization, through a signed Department authorized representative form.
B
Benefit Month – A calendar month for which benefits are issued.
Budget Month - The month that the financial and nonfinancial criteria of the filing/assistance unit are evaluated to determine eligibility and to calculate the benefit amount. When using prospective budgeting, the budget month is the same as the benefit month.
Budgeting - Calculating the amount of money to be paid to the assistance unit for the benefit month.
Bureau of Indian Affairs - BIA - An agency of the federal government of the United States whose responsibilities include providing health care to American Indians.
C
Care and Control - The physical care, guidance or maintenance of a child or children provided by a responsible parent or specified relative.
Cash Surrender Value - The amount of money which the owner of a life insurance policy would receive if the policy were converted to cash.
Cash Value - For assets— the amount that would be paid, in the community of residence, if the resource was sold or converted to cash. For income— the amount of the income or the value assigned to the services rendered for in-kind earned income.
Child Support - Voluntary or court ordered payment by an absent parent to meet the financial needs of the child(ren).
Child Support Supplemental Payment / Gap - A payment issued to TANF/PaS families based on current child support collected from a non-custodial parent. The Gap payment cannot exceed the difference between the Standard of Need and the maximum grant for the household size.
Collateral Contacts - Knowledgeable individuals or sources who serve to support or confirm information provided by the applicant/client.
Confidential Information - Applicant or client information that may only be shared for establishing eligibility, determining amount of assistance, and/or providing services, with related federally mandated and assisted programs and agencies under contract to the Department and/or pursuant to a Memorandum of Understanding.
Corrective Payment - The payment of money to an individual who has received less than they were entitled to receive as determined by the Department, including decisions made by the Department Fair Hearings Officer.
Cost-of-Living Adjustment - COLA - A change to income based on the expected change to the basic cost of living.
Countable Income - The total of earned and unearned income, minus disregards, that is not excluded by policy, and is expected to be received by the assistance unit for the budget/benefit month.
D
Deduction - The amount subtracted from an income which represents an expense that has been made or must be made by an assistance group member or an individual whose income is counted when determining eligibility. This expense is also known as an “allowable deduction”.
Deemed Income - Income of certain individuals who live with and are related to the minor child but who are excluded from the assistance group and do not receive benefits.
Deeming - A budgeting process which considers a portion of income of one person as the income of a second person. This process assumes a legal obligation of the first person to support the second person.
Deficit Reduction Act - The Deficit Reduction Act of 2005, which contains federal language and regulations regarding the reauthorization of the TANF program.
Dependent - A child who receives more than 50% of their support from a specified relative.
Direct Child Support - Support payments a custodial parent receives directly from a non-custodial parent.
Disability - The physical or mental impairment of an individual that may be either temporary or permanent.
Disabled - Prevented from working because of physical or mental impairment, disease, vision loss, or a combination of these conditions as determined by the Social Security Administration or the Department’s Medical Review Team.
Disregard - A dollar amount or percentage designated for a specific purpose that is not counted in the determination of eligibility and/or the amount of assistance.
Division of Support Enforcement and Recovery – DSER - a unit within the Department’s Office for Family Independence which is responsible for the development and implementation of the rules, regulations, policies, and procedures necessary to assure that all non-custodial parents are contributing to the economic support of their children.
Domestic/Family Violence - Physical, sexual, mental, and/or emotional abuse of a member of the assistance unit by a person with whom that member lives or with whom that member has recently lived.
E
Earned Income - Cash or in-kind benefits received as payment for work performed either as an employee, through the receipt of wages, salaries, tips, or commissions, or as a self-employed individual.
Earned Income Disregard - A dollar amount subtracted from earned income that is designated for a specific purpose that is not counted in the determination of eligibility or the amount of assistance.
Earned Income Tax Credit - EITC - A federal and/or state refundable tax credit for low or moderate income working individuals and families. This may be received once a year as a refund.
Electronic Benefit Transfer - EBT - The method of issuing financial assistance benefits to an account which is accessed by an individual through a magnetic striped debit card.
Electronic Funds Transfer - EFT - The method of issuing financial assistance benefits as a direct deposit into an individual’s personal bank account.
Elderly - Age 65 or older as of the last day of the month consistent with 22 M.R.S. § 3762(3)(B)(2)(a).
Eligibility Period - The period of time the individual is determined to be eligible for benefits.
Eligible Child - A child under age 18, or between the ages of 18 and 20 enrolled as a full-time student in a high school or an equivalent instruction alternative, leading to a high school diploma.
Emancipated Minor - A minor child who is no longer a dependent of their parent(s) due to court action or marriage. For eligibility purposes such child is considered an adult.
Emergency Assistance - EA – A short-term program benefit to assist families in an emergency situation caused by the occurrence of an unforeseen circumstance.
Equity Value - The current fair market value minus any encumbrances against the property as of the date of evaluation.
Evidence - Something that furnishes proof.
Excess Child Support - Money received from the absent parent that is in excess of the monthly TANF/PaS grant.
Excluded Asset -Any real or personal property that is not counted toward the general asset limit.
Excluded Income - Specific types of income which are not counted in the determination of eligibility or the amount of assistance.
Executive Office for Immigration Review (EOIR) - conducts immigration court proceedings, appellate reviews and administrative hearings.
Exempt Months - Months that are not counted toward the 60-month lifetime limit.
Extension – A Department decision which permits families to receive additional months of TANF beyond the 60-month lifetime limit if certain criteria is met.
F
Fair Hearing - An opportunity for any persons whose claim for assistance has been denied, or has had other negative action taken on their case, to present convincing evidence to reverse the original decision.
Fair Market Value - The amount of money that the sale of property would bring on the open market in the community where the property is located.
Family Contract - A Department form signed by a representative of the Department and each TANF/PaS specified relative that states the responsibilities of the parties to the agreement, including but not limited to cooperation in child support enforcement and determination of paternity, and the requirements of the ASPIRE Program participation.
Federal Poverty Level – FPL - A measure of income used to determine eligibility and when applicable, recipient premiums for many low income programs. The poverty guidelines are updated periodically in the Federal Register by the U.S. Department of Health and Human Services under the authority of 42 U.S.C. 9902(2).
Filing Unit - The group of family members drawn into the assistance group according to their relationships with one another.
Fleeing Felon - An individual who has been convicted of a felony and is fleeing prosecution or incarceration.
Foster Care - A legal action that places a child in the custody/control of a person or entity other than the child’s natural or adoptive parents by a state.
Fraud Investigation and Recovery Unit – FIRU - The unit of the Department’s Office for Family Independence authorized under 22 M.R.S. § 13 to investigate fraud, attempted fraud, commingling or misapplication of funds.
G
Garnishment - A legal action to deduct a specified amount of money from a person’s earned or unearned income.
Good Cause - An acceptable reason for an individual's action/inaction that removes the penalty for that action/inaction or relieves a requirement. When and how good cause may be established is described in further detail throughout the manual.
Grant - The TANF/PaS cash assistance money payment issued to an assistance group.
Gross Earned Income (employed by another) - The total amount of wages, salaries, tips, commissions, and/or the dollar value of in-kind benefits received by an employee as compensation for work performed before any payroll deductions or garnishments are subtracted.
H
Higher Opportunity for Pathways to Employment – HOPE - An assistance program for students who are parents of minor children. This program provides support services such as child care and transportation and voluntary student navigation services.
HIPAA – The Health Insurance Portability and Accountability Act of 1996, P.L. 104-191, 110 Stat 1936, requiring the protection and confidential handling of Protected Health Information.
Head of Household - Primary contact person in a household.
Hearing Request - A clear expression, orally or in writing, by the applicant/client, or the authorized representative acting on their behalf, to the department requesting the opportunity to present their case to a higher authority due to a dispute in case determination.
Home - The principal place of residence; the family setting in which the child lives with a specified relative, who provides the day-to-day care and control of the child. For resource purposes: a home is the current place of residence which is owned by the specified relative and which includes any building and the land upon which it is located, the land that appertains (belongs) to the home and all the buildings and/or mobile homes located thereon.
Homeless - Having no fixed address nor living in a permanent dwelling.
Household - People who live together.
I
Immigration Court - is the primary function of the Executive Office for Immigration Review (EOIR) within the United States Department of Justice (DOJ) under delegated authority from the United States Attorney General.
Inaccessible Assets - Resources not legally available to the individual. Resources which may become legally available to the individual through reasonable effort, regardless of penalty incurred, are not considered inaccessible. Any penalty incurred or which would be incurred in accessing the resource must be deducted from the value of the resource for the purpose of determining eligibility.
Incapacity - A physical or mental illness or impairment diagnosed by an Acceptable Medical or Mental Health Source as sufficiently serious enough to eliminate or substantially reduce the client’s ability to obtain or retain employment.
Income - Cash payments or in-kind benefits which are regular and recurring, or which are treated as available for use regardless of actual receipt, such as deemed income.
Income-in-Kind - Goods, commodities, or services (such as meals, clothing, lodging) provided as a contribution or compensation for work instead of cash.
Income Producing Property - Property that is, in and of itself, producing income.
Individual Income - All available income received on behalf of or by one person.
Individual Retirement Account - IRA - A tax deferred pension or plan that sets aside money now for the planned needs of the person after retirement.
Indian Country - Within the geographical boundaries of a reservation.
Indian Custodian - Any Indian person who has legal custody of an Indian child under tribal law or custom or under State law or to whom temporary physical care, custody, and control has been transferred by the parent of such child.
Ineligible - Not entitled to receive benefits because of not meeting one or more of the specified financial or non-financial eligibility requirements.
Inheritance - Property received or anticipated to be received from a relative or other person by legal succession or will.
Initial Eligibility Determination - The act of evaluating eligibility factors for each child and specified relative who apply for TANF/PaS cash assistance and finding the case eligible or ineligible.
Insurance Settlement - The money received by a person(s) from a company for damage to property or injury to person.
Interstate Compact on the Placement of Children - ICPC - An agreement among all 50 states that coordinates the movement of children across state lines for the purpose of placement in foster care, adoptive homes, group homes, residential treatment centers, or on a trial basis with a parent.
J
Joint Custody – A domestic relations agreement that both parents are to function as providers of maintenance, physical care, and guidance of the child(ren). The actual circumstances may or may not indicate this is occurring.
Jointly Owned Property – Property presumed to be owned in equal shares by each of the persons holding a legal interest, unless otherwise specified in a legal document such as a deed or divorce decree. A court-ordered right of ownership takes precedence over any contrary verbal claim or stipulation on any document.
L
Legal Guardian - A person who has the legal authority to care for the personal and property interests of another person as determined by the court.
Lien/Encumbrance - A security interest or claim upon real or personal property to ensure satisfaction of a debt. The lien amount must be paid up for title to the property to be transferred from one owner to another.
Living With - To be "living with" a specified relative the child must live in that relative's home. The home is where the family lives or is staying. It does not have to be their own home or their permanent home. It does not have to be an apartment or a house.
Liquid Assets - Resources which can be readily converted to cash, such as cash, checking or savings accounts, certificates of deposit, and stocks or bonds.
Loan - A transaction in which money is given to another and must be repaid.
Low-Income Home Energy Assistance Program – LiHEAP - A federal program that helps low income households pay for heating or cooling their homes.
Lump Sum Payment - Cash received on a non-recurring or irregular basis that may not reasonably be anticipated. Includes insurance settlements, inheritances, retroactive payments of RSDI, VA, SSDI, SSI and Unemployment Insurance.
M
Maintenance - The provision of the supplies or funds needed to sustain basic needs.
Minor Child - A child who is under age 18.
Minor Parent - An individual under age 18 who has a minor child; who is not married or emancipated by the court.
Month Received - The benefit month in which money may be reasonably anticipated to be available to the applicant or client or in which the person will receive money in-hand. SSA and SSI payments are exceptions to this definition, as the payment is made at the end of a month (usually because of holiday mail) for use during the following month.
Mutual Fund - A company without fixed capitalization, freely buying and selling its own shares and using its capital to invest in other companies.
N
National Automobile Dealers Association (NADA) Used Car Guide - A private publication giving standard values for motor vehicles.
Net Earned Income - An individual’s monthly gross earned income minus all allowable employment-related disregards. Also known as net monthly earned income.
Net Income - Gross income minus all allowable income disregards and deductions.
Noncitizen - A person residing in the United States who is not a United States citizen.
Noncitizen Sponsor - A person or any public or private agency or organization who executed an affidavit of support or similar agreement on behalf of a noncitizen (who is neither the child of the sponsor nor the sponsor’s spouse) as a condition of the noncitizen’s entry into the United States.
Non-Custodial Parent - NCP - A natural or adoptive mother or father who is not living in the home of the child.
Nonliquid Asset - A resource which cannot reasonably be readily converted to cash, such as vehicles, buildings, or land.
Non-financial Criteria - Eligibility criteria not based on income or assets.
Non-welfare Child Support - A child support obligation and/or payment received on behalf of a child who is not in receipt of TANF or associated with and outstanding TANF debt.
O
On-going Eligibility - The act of evaluating each open case and finding the case eligible or ineligible.
Orientation - A process to provide applicants with information on program requirements, available supportive services, and their rights and responsibilities.
Otherwise Eligible - Not precluded from eligibility by some other provision of Maine statute, Title IV-A of the Social Security Act or P. L. 104-193, the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), and the individual meets all non-financial criteria.
Overpayment – Amount of a financial assistance payment received by or for the benefit of an assistance unit that exceeded the amount for which that unit was actually eligible.
P
Parent - Specified relative who is a natural/adoptive parent or a stepparent (related by marriage to the child's natural/adoptive parent) or a person considered by law to be a parent in the case of a child conceived by artificial insemination.
Parents as Scholars - PaS – A monthly cash assistance program for parents of minor children who are matriculating in postsecondary undergraduate two-year and four-year degree-granting education programs.
Pension Fund - An investment account (typically with an employer) that is intended to provide income at retirement.
Pension Payment - A sum of money paid regularly as a retirement or disability benefit.
Perjury - A willful false statement of a material fact; swearing to what is untrue; or, incompletely answering all questions under oath with an intention to deceive.
Personal Property - All belongings owned by the applicant or client that are not considered real property.
Physical Care - The attention given to the physical needs of a child or children.
Place of Residence - A person’s primary abode where they live more than half the time.
Probation/Parole Violator - An individual not fulfilling the requirements of their probation/parole.
Processing Month - The month in which computer entries are made and confirmed.
Proof - Documentation or information that establishes the accuracy of statements made by the individual.
Prorate – To divide or distribute benefits proportionally based on number of days eligible in the benefit month.
Prospective Budgeting - Calculating eligibility and/or benefit amount by using the best estimate of the income and circumstances that are expected to exist in the benefit month.
Protective Payee - The individual, other than the specified relative, to whom payment is made and who manages the family’s benefit for the purpose of safeguarding the health and welfare of the child(ren).
PRWORA- Personal Responsibility and Work Opportunity Reconciliation Act of 1996– P.L. 104-193 replaced the Aid to Families with Dependent Children (AFDC) program with the Temporary Assistance for Needy Families (TANF) program. Establishing basic federal program requirements for TANF and strengthening the child support system.
Q
Quality Control – QC - a unit with the Department’s Office for Family Independence that regularly conducts internal audit type activities to ensure program integrity in benefit issuance and timeliness.
Questionable - Inconsistent with— other statements made by the individual, information provided for current or past requests for assistance, or information received by the Department from other sources.
R
Real Property - Resources in the form of real estate, such as land or buildings.
Recoupment - The collection or recovery by the Department of the value of assistance erroneously paid to an individual.
Redetermination - A review of all financial and non-financial requirements affecting eligibility and/or benefit amount.
Resident - A person who lives in Maine with the intent to make it their home.
Retirement, Survivors, and Disability Insurance - RSDI - A program operated by the Social Security Administration that provides a monthly income to retired people, survivors or dependents of insured people, and people with disabilities.
Room and Board Income - Money received for providing meals and/or rooms to people not included in the assistance group.
Roomer - An individual residing with others and paying reasonable compensation to others for lodging, but not for meals.
S
Sanction - A penalty imposed against a client for failure to cooperate with requirements of the ASPIRE Program, DSER, and/or other means tested programs that specifically require such a penalty.
Section 8 Housing - A federal rent subsidy program now referred to as the Housing Choice Voucher Program. The tenant pays a portion of the rental cost based on a percentage of their income. The balance of the rental cost is paid by the federal government. Also known as deep subsidy.
Self-Employment - The act of engaging in a trade or business not under the control or direction of an outside employer with the intent to generate earnings or benefits where those earnings are not reported on a W-2.
Shelter Costs - The amount of money required to provide housing.
Social Security Administration - SSA - A United States government agency that administers specific social programs covering disability, retirement and survivor’s benefits.
Social Security Disability Insurance – SSDI - Benefits issued to individuals who can’t work because they have a limiting medical condition that’s expected to last for at least one year or result in death.
Social Security Number – SSN - A nine-digit number that the United States government issues to all U.S. citizens and eligible U.S. residents who apply for one.
Specified Relative - A person related to the minor child within the fifth degree of kinship by blood, marriage, or adoption who lives with the child; a legal guardian or Indian Custodian who lives with the child.
Standard of Need - The amount of income necessary to meet the full need in relation to household size.
Step Disregard - The method of reducing a certain percentage of a TANF/PaS recipient’s earned income for the first six months of employment.
Stepparent - An individual who is currently legally married to a child’s natural or adoptive parent but has no biological or adoptive parental relationship to the child.
Striker - Anyone who participates in a strike or work stoppage (including a stoppage due to the expiration of a collective-bargaining agreement) or any concerted slowdown or other interruption of operations by employees.
Subsidized Housing - Housing leased under an agreement in which the household pays a rate based on a percentage of the household’s income. The balance of the rent is paid for by the federal government. Also known as deep subsidy housing, conventional public housing, or the Housing Choice Voucher Program (formerly known as Section 8 housing).
Supplemental Security Income - SSI - Federal payments made under authority of Title XVI of the Social Security Act.
Systematic Alien Verification for Entitlements - SAVE - A process which allows access to U.S. Citizenship and Immigration Service (USCIS) data to validate the immigration status of non-citizen applicants.
T
TANF Cash Assistance - A time-limited cash assistance program designed to provide families with opportunities leading to self-support.
Temporary Absence - The condition created when a member(s) of the assistance unit is away from the home for a specified period of time not to exceed 45 days except in limited circumstances.
Temporary Assistance For Needy Families - TANF – Welfare provided under Title IV-A of the Social Security Act which authorized the TANF block grant as a result of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996.
Termination - The closure of a case and/or removal of an individual from program eligibility.
Timely Notice - Written notification mailed at least ten days prior to the date of the action.
Title IV-A - The section of the Social Security Act authorizing the TANF program.
Title IV-D - The part of the Social Security Act that authorizes establishing paternity and collecting child support.
Title IV-E Foster Care - Foster care payments authorized under Title IV-E of the Social Security Act.
Transfer - The act of moving the right, title or interest in property, or a portion thereof, from one person to another by sale, gift or exchange. Also includes transfers to joint tenancy or to tenancy in common.
Tribal Land Claim Settlements - Settlements of property claims between the Federal government and Indian Tribes under Public Laws 92-03, 94-89, 94-14, 94-40, 95-33, 96-20, and 93-31.
Trust - Any arrangement in which a grantor transfers property (real or personal) with the intention that it be held, managed, or administered by a trustee(s) for the benefit of the grantor or other beneficiary(ies). Trusts are managed by individuals or entities with fiduciary obligations.
Trustee - Any individual(s) or entity that manages a trust and has fiduciary responsibilities.
U
Underpayment - The payment of a level of assistance that is less than the amount that an assistance group is rightfully entitled to receive, or the failure of the Department to issue benefits to an eligible assistance group.
Unearned Income - All contributions, payments, pensions, benefits, loans, awards, etc. which are not received as compensation for work performed. No deductions are allowed from unearned income unless otherwise instructed.
Unemployment Insurance Benefits – UIB - Financial assistance for eligible workers who become unemployed through no fault of their own and meet other eligibility requirements as determined by the U.S. and Maine Department of Labor.
United States Citizenship and Immigration Services - USCIS - (formerly INS) – An agency of the U.S. Department of Homeland Security (DHS) that administers the country’s naturalization and immigration system.
United States Department of Justice (DOJ) - a federal executive office responsible for the enforcement of federal law.
Utilities - The services provided for water, sewer, electricity, telephone and heating/cooking fuel.
V
Vendor - The person or business that provides goods or services.
Vendor Payments - A portion of assistance paid directly to a vendor on behalf of an assistance group.
Verification - A document or written statement attesting to the validity of a fact or event that is needed to determine eligibility or establish compliance with program requirements.
Verify - To check, confirm or establish whether a statement or condition is true or accurate by obtaining a copy, viewing a copy or obtaining a verbal description of the evidence.
W
Workforce Innovation and Opportunity Act – WIOA - Services designed to help job seekers access employment, education, training and support services to succeed in the labor market and to match employers with the skilled workers they need to compete in the economy. These services are administered by the U.S. and Maine Department of Labor.
LEGAL BASIS:
Federal legislation, the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), Public Law 104-193 enacted August 22, 1996 provides states with an opportunity to administer a financial aid and job preparation program. As a condition of receipt of a Part-A, Block Grant for Temporary Assistance for Needy Families (TANF) under Title IV of the Social Security Act, Maine agrees to administer a welfare program in accordance with the rules of PRWORA, provisions of its State Plan, and all applicable State laws and regulations.
GENERAL RULE:
TANF provides temporary financial assistance to families with needy dependent children while the family works towards becoming self-supporting.
PROGRAM REQUIREMENTS:
Basic eligibility criteria and program requirements are contained in chapters I through IV and are arranged by subject. Chapter order follows the eligibility determination process generally used for new applicants.
Confidentiality:
The Department of Health and Human Services must by Federal and State rules provide for the basic rights and dignity of all applicants or recipients of financial services regarding their confidentiality. The Department must ensure that information about the recipient is maintained in a confidential manner and only released under certain circumstances.
NOTE: All employees of the Department must adhere to this policy.
Address Confidentiality Program
The Address Confidentiality Program, administered by the Secretary of State, provides address confidentiality for victims of domestic violence, stalking or sexual assault and requires state and local agencies and the courts to accept a designated address as the program participants’ address when creating a public record. When an applicant or recipient verifies that they are a certified participant in the Address Confidentiality Program, the designated address is the only address accepted and provided when staff is required to release information in each circumstance described in pages 1 through 3 of this chapter.
Information requested from outside the Office for Family Independence shall be released by the following:
Permission:
Whenever possible, the individual shall be informed of any outside request for information. Permission for release of information shall either be provided by the inquiring source or requested from the recipient. In an emergency situation when a release cannot be obtained and releasing the information would be in the best interest of the client, they shall be notified promptly of the disclosure and the reason for it.
NOTE: The Department shall not release identifying information to absent parents without release from Specified Relatives.
Subpoena:
When the court subpoenas a record or an agency representative to testify concerning an applicant or recipient, the Department's representative shall bring to the court's attention the statutes and regulations regarding disclosure. The decision then rests with the presiding judge.
NOTE: The above conditions apply to requests from other government authorities, courts and law enforcement agencies unless the situation is described in iii(f).
Program Administration:
The release of information must be limited to programs which establish eligibility and provide services through agencies subject to comparable standards of confidentiality. The Department shall release information for the following─
a. Investigation and Recovery
b. Fair Hearing Preparation: The Department shall make all information pertaining to a decision on eligibility, including medical and social data available to the applicant or recipient or their authorized representative.
c. General Assistance: The Department shall provide, to the municipality, financial information necessary to make a determination as to the need and amount of General Assistance. The Department shall not provide Medical reports without the individual's written permission.
d. Law Enforcement: The Department shall provide the current address of a recipient to a Federal, State or local law enforcement officer upon request of the officer if the officer provides the agency with:
1. The recipient's name and enough information to identify the individual, and
2. Notification that the individual is fleeing to avoid prosecution or custody or confinement after conviction or that the individual has information that is necessary for the officer to conduct the official duties of the officer and the location or apprehension of the recipient is within such official duties.
e. Other Social Service Agencies: The Department shall provide information upon receipt of written authorization from the individual.
NOTE: This authorization is not required of Social Services within the Department; however, they are required to seek permission of the Worker to access the record and may not remove it without permission.
f. Suspected Child Abuse or Neglect: Information regarding suspected child abuse or neglect of any child on the assistance grant must be reported to Department of Human Services Bureau of Child and Family Services. Also, information must be released to any local or state agency or official legally authorized to investigate child abuse and neglect under Maine law.
g. United States Citizenship and Immigration Services (USCIS): The Department shall not provide information regarding counterfeit, altered or fraudulent documentation used to obtain benefits unless it has been requested by USCIS in writing for criminal investigation.
D. APPLICATION PROCESS
All individuals have the right to file an application for TANF/PaS benefits. Completed referrals received from qualified public educational institutions are considered an application for PaS only.
Minimum Requirements:
The applicant or their authorized representative must:
i. Complete and sign, under penalty of perjury, an application;
ii. Complete an interview; and
iii. Sign a Family Contract.
All filing unit members who are mandatory ASPIRE-TANF participants must:
Sign a Family Contract; and
Complete an orientation meeting within 30 days of application.
EXCEPTION: When circumstances beyond the control of a mandatory ASPIRE-TANF participant prevent them from completing an orientation meeting within 30 days, the Department shall grant the application, if otherwise eligible, and require the completion of the orientation meeting within the second 30 days following application, i.e., within 60 days of the original application. When good cause claimed is based on domestic violence an individual may not be required to participate in orientation until the good cause determination is made. See 10-144 C.M.R. 607 ASPIRE-TANF Rules.
The Interview:
Orientation to TANF programs begins with the initial interview. During the initial interview of the application process, the Department shall provide applicants with information about coverage, conditions of eligibility and rights and responsibilities including information, both orally and in writing, of the availability of services for victims of domestic violence.
Responsibility of Office Staff:
Office staff or their representative shall advise all TANF/PaS applicants and recipients of the availability of the ASPIRE-TANF program and other services, including the following:
Education, employment, and training opportunities available;
Support services available during participation, and available transitional services when TANF/PaS eligibility stops;
Assistance in establishing paternity and obtaining child support and reminding the applicant/recipient of their responsibility to cooperate unless good cause exists (Chapter II(G));
The grounds for exemptions from participation, the consequences for refusing or failing to participate, and Good Cause for non-participation. Voluntary participants, who are otherwise exempt (Chapter II(H)(2)), shall be informed that their failure to participate shall not result in sanctions;
Information about the PaS Program;
Information about Earned Income Tax Credit; and
The criteria which must be met to remain eligible beyond 60 months.
The Family Contract:
a) During the initial interview, a representative of the Department and the TANF/PaS family must enter into a contract by signing a form referred to as the Family Contract. The Family Contract states the responsibilities of the parties to the agreement including, but not limited to, cooperation in child support enforcement and determination of paternity; the requirements of ASPIRE-TANF Program participation; and referral to parenting activities and health care services.
NOTE: Signing the Family Contract does not waive the person’s right to appeal anything in the Family Contract with which they disagree.
The Family Contract must be signed by TANF/PaS specified relatives. The Family Contract must be amended to include individual employability plans as filing unit members enter the ASPIRE-TANF program and when participation review occurs. Written copies of the Family Contract and notice of the right to a fair hearing must be provided to the individual at the initial signing and whenever the Contract is amended.
i. Refusal to sign the Family Contract Amendment:
The Department shall sanction any specified relative who refuses to sign the Family Contract amendment. The sanction shall follow the policy pertaining to non-compliance with the ASPIRE-TANF Program.
Orientation:
All filing unit members who are mandatory ASPIRE-TANF participants must complete a TANF orientation meeting to complete the application process unless good cause exists (See Good Cause below).
Good Cause:
If an applicant or mandatory ASPIRE-TANF participant indicates that there is a reason not to complete the Orientation meeting, the Department must determine whether they qualify for “good cause”. An individual may not be required to participate in any TANF activity including the orientation meeting until the good cause determination is made.
Good cause exists when the individual or the child is a victim of domestic violence, (which includes physical injuries or the psychological effects of abuse), and participation in ASPIRE-TANF could result in physical or emotional harm to the child or other family member. Domestic violence victims may volunteer to participate in an orientation meeting.
The full definition of domestic violence for the determination of good cause is the inability to participate because of physical injuries or the psychological effects of activities related to abuse; because the abuser actively interferes with the individual’s participation; because the location puts the individual at risk; or for other good cause related to domestic violence. For the purposes of this subsection, reasonable and verifiable evidence may include but is not limited to the following:
Court, medical, law enforcement, child protective, social services, psychological or other records that establish that the individual has been a victim of domestic violence; or
Sworn statements from persons other than the individual with knowledge of the circumstances affecting the individual.
iii. A sworn statement from the applicant may be provided attesting to the circumstances that make the individual unable to attend orientation; or
iv. A department issued form may be completed and signed, attesting to the circumstances that make the individual unable to attend orientation. Supporting documentation may be required if articulable doubt exists regarding the credibility of the provided self-attested statements or forms.
NOTE: When a determination of good cause is made, the ASPIRE-TANF program may contact the individual and offer domestic violence victim services or other appropriate services including an orientation meeting on a voluntary basis.
Verification and Documentation:
The Department shall seek necessary clarification and verification, first, from the applicant. With the exception of public records, the Department may not gather verification without the applicant's knowledge and consent. The Department shall advise the applicant what questions remain unanswered, what needs to be provided, and verification due date. The due date must be at least 10 days from the date the notice is provided. The applicant must provide the requested materials by the later of the specified due date or 30 days from the date of application.
Situations requiring additional information include, but are not limited to:
Discrepancy in income or resources;
Parent deceased, no Social Security income declared;
Unemployed, no unemployment insurance benefit declared;
Information incomplete;
Community complaints; or
Evidence of potential resources.
The applicant has the primary responsibility for providing verification to support statements made on the application. If the applicant cannot supply or has difficulties in obtaining the required verification, the Department must assist the applicant and explore good cause.
i. Examples of acceptable verification include, but are not limited to:
a. Wage stubs;
b. Employer statements;
c. Award letters;
d. Bank statements; or
e. Collateral contacts.
ii. Examples of good cause include, but are not limited to:
a. An employee feels they would get fired if a collateral contact was made, or
b. A foreign government refuses to verify an ex-employee's wages.
The Department must document in all case files reasons to support such decisions.
c) Verification Other Than at Application:
The Department shall use the same verification procedures that are used for initial application in subsequent eligibility and benefit level decisions.
Applicant Notification:
Notification of approval is in writing and contains the following:
Dates of financial eligibility;
NOTE: Applicants may be notified of their eligibility for other benefits separately
Income used to determine eligibility and benefit level;
Regulation supporting approval; and
Explanation of applicant's right to a fair hearing.
Notification of denial is in writing and contains the following:
Statement of denial action;
Reason for denial;
Citation of policy supporting denial; and
Explanation of applicant's right to a fair hearing.
Time and Processing Standards:
Benefits are calculated from the date of application or from the date of statutory eligibility, whichever occurs later.
NOTE: The initial month’s benefit is prorated according to the Table of Percentages in the Appendix.
The Department must make a decision within 30 days of application. This time standard shall not be used as a waiting period or as a basis for denial.
The Department shall determine eligibility after both the initial interview and the orientation meeting are completed.
NOTE: The Department shall use the same procedure when mailing a decision notice or benefit to the designated address of a participant in the Address Confidentiality Program (ACP) (C(1)(a) above). The administrators of the Address Confidentiality Program then forwards the mail to the ACP participant. Therefore, the ACP participant may experience delays in receiving decisions and benefits.
When an applicant refuses to provide required information or verification, the Department shall:
Make sure the applicant understands that benefits will be denied unless the information is provided;
Document the refusal; and
Deny the application.
When an applicant fails to provide required information or fails to contact the Department by a specified date without good cause, the Department shall:
Document the failure to contact or provide required information; and
Deny the application after the specified date.
When an applicant has good cause for failing to provide required information, the Department shall:
Offer to provide assistance in obtaining the information;
Waive a requirement under extraordinary circumstances when the proof is unlikely ever to be available and obtaining it is outside the control of the client or Department;
Keep the application pending an additional 30 days while the client or Department continues their attempt to get the required proof;
Grant the application back to the original date of application when required proof is obtained within the second 30 day-period providing that the client is eligible to that date; or
Deny the application when the required information is not provided within the second 30-day period.
Good Cause Reasons Include:
i. Natural disasters, such as fires or floods, having a direct impact on the applicant/recipient or an immediate family member;
ii. Illness of such severity on the part of the applicant/recipient or an immediate family member that the applicant/recipient is unable to direct their personal affairs;
iii. Refusal of an employer to provide earned income verification, or the unavailability of an employer to provide verification before the deadline;
iv. Lost or stolen mail;
v. Refusal of a landlord to verify housing expense;
vi. Death of the applicant/recipient or an immediate family member; or
vii. Inability of a third party (such as Social Security Administration) to provide the necessary documentation within the designated time period.
g) When good cause does not exist as defined above, the Department shall:
Document the explanation given for the failure and why it does not establish good cause; and
Deny the application.
NON-PAYMENT SITUATIONS
Although eligibility may exist there are some situations in which a TANF/PaS payment cannot be made.
Concurrent Assistance:
TANF/PaS: Individuals cannot be included as members in more than one filing unit in the same month; nor can there be more than one set of specified relatives in the same month. This also applies to individuals moving from one state to another.
NOTE: In the event another state pays semi-monthly and the recipient received only half of the monthly benefit, that individual is eligible for a partial monthly benefit from Maine. If the client applies in the first half of the month, the Department shall prorate from the first day of the second half of the month. If the client applies during the second half of the month, the date of application is used for proration.
NOTE: Count the TANF/PaS payment received in the previous state. Do not count other income received in the previous state because it was considered in the calculation of that state's TANF/PaS payment.
SSI: See Filing Unit, Chapter II.
Foster Care: See Filing Unit, Chapter II.
Interstate Compact: See Relationship and Maintenance of a Home, Chapter II
Penalties for Convictions:
TANF/PaS assistance must not be provided for any individual who is:
Convicted in Federal or State court of having made a fraudulent statement or representation with respect to the place of residence of the individual in order to receive assistance simultaneously from two or more states under funds provided through the TANF Block Grant, Medicaid, the Food Stamp Act of 1977, or the Supplemental Security Income (SSI) program. These individuals are ineligible to receive TANF/PaS benefits for a period of ten years from the date of conviction.
NOTE: The prohibition from receipt of assistance does not apply to any months following the granting of a pardon of such a conviction by the President of the United States.
Fleeing to avoid prosecution, custody, or confinement after conviction, under the laws of the place from which the individual flees, for a crime, or an attempt to commit a crime, which is a felony under the laws of the place from which the individual flees (referred to as a “high misdemeanor” in New Jersey); or
Violating a condition of probation or parole imposed under Federal or State law.
REDETERMINATION (REVIEW) PROCESS
All cases must have eligibility for continued assistance re-determined periodically.
Redetermination requires:
The recipient and/or their representative must:
Submit a signed review form, and
Complete an interview
As in the application process the recipient has the primary responsibility for providing verification to support statements made on the review form or during the face-to-face or telephone interview.
The recipient and/or representative is allowed the entire month of review to complete the process.
The Department must:
a) Notify the recipient and/or their representative of the results of the review using timely and adequate notice procedures.
b) If the recipient cannot supply or has difficulty in obtaining the required verification, Department staff shall assist them.
NOTE: At least once a year, the Department shall inform recipients of the criteria that must be met to remain eligible beyond 60 months.
Redeterminations must take place at least every 12 months.
QUALITY CONTROL REVIEW
TANF/PaS households who refuse to cooperate in any quality control review are not eligible for benefits until they comply.
CHANGE PROCESS
All individuals are required to report changes which affect eligibility. The Department is required to act on reported changes timely.
Timely Reporting:
Families must report within 5 days of the date it becomes clear that a child will be out of the home for 45 days or more.
All other changes in circumstances such as income, assets, household composition, marital status and residence must be reported within ten days of occurrence. For income purposes "occurrence" is the date the change in income is received.
NOTE: When changes are reported timely, the month in which the change occurred shall be considered a correct payment month even when ineligibility begins in that month.
c) Earned income disregards are not allowed in determining overpayments when an individual failed, without good cause, to report timely. Good cause reasons include:
Mail delay,
Illness of the employed individual, and
iii. Other unanticipated emergencies.
Treatment of Changes:
A change resulting in an increase in benefits affects the next payment. If the increase cannot affect the next payment the Department shall authorize a corrective payment.
NOTE: With the exception of adding individuals, families that report any changes resulting in grant increases shall not receive a corrective payment for the month of report. The corrective payment is prorated from the date that the individual entered the household or met eligibility requirements or complied with ASPIRE or DSER requirements.
A change resulting in a decrease in benefits shall affect the next payment depending on timely notice requirements.
TIMELY/ADEQUATE NOTICES
The Department must provide the recipient with timely and adequate notice when the action is to discontinue or reduce the payment. The Department must provide the recipient with adequate notice when the action is to increase or continue the payment at the same level.
Timely notice must be mailed 12 days before the change is effective (10 days for notice - 2 days for mailing).
a) The Department shall use the same procedure when mailing a decision notice or benefit to the designated address of a participant in the Address Confidentiality Program (ACP). The administrators of the Address Confidentiality Program then forward the mail to the ACP participant. Therefore, the ACP participant may experience delays in receiving decision notices and benefits.
b) Timely notice is not required in the following instances:
The recipient or the payee dies;
The recipient requests in writing that the case be closed;
The recipient has been committed to a public non-medical institution;
The recipient has been placed in skilled nursing care, intermediate care or long-term hospitalization;
The recipient's whereabouts are unknown and departmental mail has been returned; or
A child is removed from the home as a result of a judicial determination.
Adequate notice includes a statement of—
The action the Department intends to take;
The reason for the action;
The policy citation supporting the action; and
An explanation of the right to request a hearing and, if it is requested within 12 days from the date of the notice, the benefit can continue at the previous level until a decision is made after a hearing. If the Agency is upheld, the continued benefit must be repaid.
60 MONTH BENEFIT LIMIT
A family may not receive TANF/PaS assistance for longer than 60 months in a lifetime except in those cases in which the department has determined that the family qualifies for an exemption, or a hardship extension, or an earnings disregard extension.
Maine law provides that all recipients of TANF cash assistance shall be subject to a lifetime limit of 60 months, whether or not consecutive.
The count for the lifetime limit on assistance begins with June 1, 1997. June is counted as month 1 of the 60 months allowed if, at the beginning of that month, state- or federally-funded cash assistance was received for either parent. The lifetime limit includes any month the family received cash assistance in any other state or territory of the United States.
Exemptions from the Time Limit:
The time limit shall not apply in the instances of:
A minor child(ren) living with a single parent who receives SSI benefits, or with two parents who both receive SSI benefits;
A minor child(ren) living with a legally responsible non-parent specified relative who is not in the assistance unit;
An adult living in Indian Territory or Trust lands (as defined by 30 M.R.S. §§ 6203(2-A – 6, 8 and 9) and 7202(2)) where at least 50 percent of the adults were not employed. The Department uses the most current biennial Indian Service Population and Labor force Estimates Report published by the Bureau of Indian Affairs (BIA), or
any successor report, as default data source to determine if the not-employed rates for areas of Indian country are at least 50 percent. A tribe may provide alternative data based on similar periods to the above referenced report, to demonstrate that the not-employed rate is at least 50 percent;
Any month of receipt in which an individual is a pregnant or minor parent who is not the head of household;
Any month for which the family received only non-cash assistance such as:
Alternative Aid,
Emergency Assistance,
ASPIRE-TANF Support Services,
Whole Family Services,
Food assistance including Transitional Food Assistance and any TANF work supplement programs,
Transitional Services including child care and transportation, or
HOPE, 10-144 C.M.R. 330.
Benefits Which Count Toward the Limit:
Receipt by a family of TANF/PaS cash assistance from Maine or from any state or territory of the U.S., regardless of the source of funding of the payment, counts as one month toward the 60-month limit when an adult or minor parent head of household is included in the family.
EXCEPTION: When a TANF/PaS overpayment has been established for a month, and that month is repaid in full, that month does not count toward the 60-month limit.
Provisions for Extensions to the Time Limit:
A family may receive benefits for more than 60 months if they qualify for an extension. If granted an extension, eligible families are issued monthly benefits according to TANF/PaS cash assistance benefit standards. In addition, these families are—
i. Subject to all TANF/PaS cash assistance eligibility requirements,
ii. Required to participate in Family Contract Amendment activities from the date of application, and
Subject to all TANF/PaS reporting requirements.
b) Any non-exempt family who has received TANF/PaS for 60+ months must meet one of the criteria for one of the hardship extensions and must—
i. Sign and be in cooperation with their Family Contract Amendment unless good cause exists,
ii. Continue to meet all other TANF/PaS eligibility requirements, and
iii. Continue to meet the criteria on which the extension was based each month of the extension period.
Failure to meet these requirements shall result in the withdrawal of the extension.
c) All extensions are temporary. An extension may be approved for up to six months.
d) Families who receive an extension have the option to request early termination of benefits and may be eligible for Transitional Services if otherwise eligible.
e) Non-compliance with required activities during an extension period shall result in case closure.
f) Verification:
The adult recipient or the minor parent head of household has the primary responsibility for providing verification to support the extension.
If that recipient cannot supply, or has difficulties in obtaining, the required verification, the Department shall assist them.
g) Extension types:
Earnings Disregard Extension: The Department shall grant an extension for a household for each month in which a family is eligible to receive TANF/PaS and to receive a Step disregard of either 100% or 75% (See Chapter IV). This extension type is only available for families that have reach reached 60 months on or after October 1, 2019.
Hardship Extension:
The Department may extend TANF/PaS cash assistance benefits beyond the 60-month limit when a family is experiencing a hardship outside of their control as defined below.
Additional incremental extensions may be granted for up to six months each unless specified below. Even if the situation of another adult, or minor parent head of household in the same assistance unit, was the basis for approval of an extension, any other adult or emancipated minor who received the benefit of the extension is considered to have received the extension.
Domestic Violence– An adult, or minor parent head of household, recipient who is a victim of domestic violence may be eligible for an extension of up to six months. Additional incremental extensions of up to six months each may be granted.
For extension purposes, domestic violence situations are defined as follows:
The adult, or minor parent head of household, recipient who is currently involved in or living with the effects of a sexual assault or domestic violence situation, which includes one or more of the following:
Physical acts/threats of physical injury,
Sexual abuse or assault of a child or caretaker of a child, or
Psychological effects of the abuse or assault.
The adult, or minor parent head of household, recipient must provide reasonable and verifiable written evidence of the abuse including but not limited to:
Court, medical, law enforcement, child protective, social services, psychological or other records that establish that the recipient has been a victim of domestic violence;
Sworn statements from persons other than the individual recipient with knowledge of the circumstances affecting the recipient;
A sworn statement from the applicant or recipient may be provided attesting to the circumstances that provide the basis for the Domestic Violence extension; or
(iv) A department issued form may be completed and signed by the applicant or recipient, attesting to the circumstances that provide the basis for the Domestic Violence extension.
(v) Supporting documentation may be required if articulable doubt exists regarding the credibility of the provided statements or forms.
When the Department grants an extension due to domestic violence it shall provide information about the services offered by domestic violence resource centers and referral contact information to the recipient. The Department shall work with the recipient to create an employment plan that includes steps to prepare for employment and economic independence as well as steps to reduce the threat of violence and increase family security. When a recipient has elected to participate in services in a domestic violence resource center, and with the recipient's written consent, the Department may request the involvement of the resource center in the development of the employment plan. Subsequent incremental extensions of up to six months each may be granted.
Disability-The adult, or minor parent head of household, recipient who is disabled may be eligible for an extension of up to six months. Additional incremental extensions of up to six months each may be granted.
The adult(s) or minor parent heads of household recipient claiming disability must—
Have a significant physical or mental impairment documented by a medical professional on a current medical form provided by the Department or a signed statement from a medical professional (see note below regarding minimum requirements) that supports the recipient’s statement of an inability to engage in
any substantial gainful activity as defined by the Social Security Administration which has lasted or is expected to last of a continuous period of at least 12 months; or
If the impairment is believed to be temporary (less than 12 months), the applicant must provide medical information that includes the length of time the applicant cannot be involved in work activities. Temporary disability is intended to cover those incapacities such as a broken limb, recovery from surgery and other short-term disabilities.
NOTE: Statements from medical professionals must be signed, dated and provided on company or provider letterhead. The letter must at a minimum contain the adult’s name, date of birth, diagnoses, information regarding any work or functional limitation(s), date of last exam, date for when the limitations began and estimated amount of time the limitation(s) are expected to last.
The request for subsequent incremental extensions must include—
An updated medical form or signed statement from a medical professional (see note above regarding minimum requirements) documenting a significant physical or mental impairment and inability to engage in substantial gainful activity. Verification must be provided annually or upon expiration of the most recent medical statement, whichever is sooner,
(ii) Documentation of the active status or documentation of the appeal of a denial of a SSI/SSDI application;
(iii) If the impairment is believed to be temporary (less than 12 months from the original medical statement), medical information including the length of time the applicant cannot be involved in work activities must be provided. Temporary disability is intended to cover those incapacities such as a broken limb, recovery from surgery and other short-term disabilities; and
(iv) If applicable, documentation of ongoing compliance in the disabled recipient’s rehabilitation employment plan as reported by the Office of Rehabilitation Services, or documentation that the disabled recipient was found eligible for vocational rehabilitation services but was placed on a wait list.
Caring for a Significantly Disabled Family Member- The adult, or minor parent head of household recipient, who is needed to care for a significantly disabled family member and is unable to engage in substantial gainful activity may be eligible for an extension of up to six months. Additional incremental extensions of up to six months each may be granted. For extension purposes all of the following conditions must be met:
The adult, or minor parent head of household, recipient is needed to care for a family member who resides in the home and would be included on the TANF/PaS grant if otherwise eligible;
The person needing care has a temporary or permanent mental or physical illness or incapacity;
(c) The recipient must provide documentation from a qualified medical professional that verifies the person who needs the care is physically or mentally disabled, as determined by medical evidence, and the person who needs the care requires assistance with daily living activities such as eating, personal care, mobility and/or medical attention; or The person who needs care requires supervision to address mental health issues that may result in harm to the person needing care or to others; and
(d) An employment plan must include a requirement that the recipient needed to care for the disabled family member develop a plan for care for the disabled family member to enable a return to employment for the caregiver or the other plan for support in anticipation of the end of cash assistance.
Participation in a Training or Education Program- An adult, or minor parent head of household, recipient who, is participating in good standing in an approved education program such as vocational education training as defined in 10-144 C.M.R. Ch. 607, ASPIRE-TANF Program Rules, Section (3)(IV)(A)(3)(a) may be eligible for an extension of up to six months. Additional incremental extensions of up to six months each may be granted.
Working Families – The adult, or minor parent head of household, recipient may be eligible for an extension of up to six months when that recipient is working at paid employment but is not earning enough to close TANF/PaS.
The adult, or minor parent head of household, who is the single custodial parent or specified relative of a child under age 6 must be working at paid employment at least 20 hours per week.
The adult, or minor parent head of household, who is the single custodial parent or specified relative of a child age 6 and older must be working at paid employment at least 30 hours per week.
Two parent families must be working at paid employment for a combined total of at least 35 hours per week if they do not receive federally funded childcare, or 55 hours per week if they do receive federally funded childcare.
Additional incremental extensions of up to six months each may be granted provided the recipient remains working at least 35 hours per week.
Working families may be eligible for Transitional Services upon case closure following the extended benefits period if otherwise eligible.
NOTE: Self-Employed recipients must demonstrate that they are working the minimum hours required per week based on their household and must be earning at least the State equivalent to the minimum wage per hour to be eligible for an extension.
Pregnancy – The adult or minor parent head of household recipient may be eligible for one extension of up to six months when they are the only adult living in the household, and are in their last trimester of pregnancy. This extension is limited to one occurrence in the adult’s lifetime.
Loss of Job – The adult, or minor parent head of household, recipient who is terminated from TANF/PaS as a result of the time limit or end of an extension and subsequently becomes unemployed, may be eligible for an extension of up to six months when—
The recipient has been employed for at least 12 months following TANF/PaS closure;
The job loss was through no fault of the recipient; and
The recipient has applied for unemployment benefits..
The extension lasts for up to six months. Additional incremental extensions of up to six months each may be granted.
Occurrence of an Emergency Situation – A family may be eligible for an extension of up to six months when the family has experienced an emergency situation, which is beyond the control of the family and prohibits them from engaging in employment. Examples of an emergency situation include but are not limited to the following:
Death of child, spouse, or parent;or
Homelessness or have an active eviction not caused by misuse of property by the tenant, tenant’s family or invitee of the tenant, including: criminal activity, substantial damage caused to the premises, or nuisance within the premises; or
Inadequate or unavailable childcare or transportation required to engage in substantial gainful activities; or
(d) Being a victim of violent crime; or
(e) Are experiencing a delay caused solely by a third-party in obtaining non-financial verifications required to make a hardship extension eligibility determination beyond the verification due date (see Ch. I(D)(5), when the applicant, or recipient, initiated attainment of the required documentation prior to the verification due date.
Additional incremental extensions of up to six months each may be granted.
h) Pre-Termination Notice and Conference:
The family has the right to request a conference prior to termination of TANF/PaS benefits to—
Contest the Department’s calculation of the termination date, and/or
Seek to establish the family’s eligibility for a hardship extension.
At the conference, the family has a right to present information and argument, to bring witnesses to testify on the family’s behalf, and to be represented by legal counsel. The pre-termination conference shall be conducted by an ASPIRE worker trained in the procedures set forth in this chapter, who shall determine, based upon the family’s case record and any evidence presented at the conference, the correct termination date for the family’s TANF/PaS benefits and/or whether a hardship extension should be granted.
No later than 120 days prior to the end of a family’s 60th month of receiving TANF/PaS, the Department shall send written notice to the family of the opportunity to request a pre-termination conference. The notice must clearly explain—
The purpose of the pre-termination conference;
That a pre-termination conference may be requested orally or in writing;
The name, address, and telephone number of the individual or office the family must contact to request a pre-termination conference;
That the pre-termination conference may be conducted by phone or in person; and
The time frame in which the family must request a pre-termination conference to ensure continuation of benefits pending the conference.
If a pre-termination conference is requested within 10 days of the date of the written notice, the family’s benefits continue until the conference has been held and a determination made, or until the scheduled termination date, whichever occurs later.
If a pre-termination conference is requested more than 10 days after the date of the written notice, the family’s benefits shall be terminated at the end of the 60th month unless the Department determines that the family qualifies for a hardship extension.
When a pre-termination conference is requested by phone, the family may choose to hold the conference at that time or to schedule a date in the future, in which case the ASPIRE worker shall send a letter indicating the date and time of the pre-termination conference.
Whether the pre-termination conference is requested by phone or in writing, the worker shall explain, either verbally or in the scheduling letter, the following to the requesting family:
The family’s right to present evidence and argument at the pre-termination conference, and to bring witnesses to provide information on the family’s behalf;
The family’s right to be represented by legal counsel at the pre-termination conference; and
That the family may request to have the pre-termination conference rescheduled or continued for good cause. This request must be made before the scheduled conference.
Following the pre-termination conference, the ASPIRE worker shall issue a letter to the family explaining the Department’s determination and advising them of the right to appeal.
If the family fails to request or complete the pre-termination conference, the Department shall determine whether the family is eligible for a hardship extension based on the information in the family’s case record.
i) Hardship Extension Decisions:
All hardship extension decisions and case closures based on the 60-month time limit are made by an ASPIRE worker pursuant to the process detailed above, and must be approved by a Supervisor.
Extension months may be retroactive to the month following TANF/PaS closure, provided the family is eligible and has not already received TANF/PaS benefits in that month. Monthly benefits are issued to eligible households according to TANF/PaS cash assistance benefit standards.
Hardship extensions shall not be granted when—
The adult recipient has rejected offers of employment or quit a job without good cause consistent with the good cause provisions (10-144 C.M.R. Ch. 607, ASPIRE-TANF Program Rules, Section 4(III)(C)) within the last year;
The adult recipient has failed to cooperate with ASPIRE, Division of Support Enforcement and Recovery (“DSER”), or Quality Control (“QC”) within 12-months of the end of the 60th month, resulting in two or more sanctions; and/or
The adult recipient has an Intentional Program Violation (“IPV”) from the Department of Health and Human Services established in the 36 months prior to the request for extension.
iv. Extension Approvals:
When granting an extension, the Department shall also determine the length of the extension and specify when the extension begins and ends. The extension must be a minimum of one month to a maximum of six months. Once an extension is granted, the adult, or minor parent head of household, recipient(s) must meet the criteria on which the extension was based each month of the extension period.
All hardship extensions granted require the adult, or minor parent head of household, recipient(s) to sign a Family Contract Amendment, containing steps to be taken, as appropriate, to remove/improve the condition that warranted the hardship extension.
The adult, or minor parent head of household, recipient(s) must be actively engaged in an approved activity or process designed to further the family’s goal of self-sufficiency.
Formal re-evaluations of hardship extensions must be scheduled.
Families that qualify for cash assistance extended benefits must be evaluated any time a change in circumstances occurs which affects the extension. Such changes might include earnings or family composition.
NOTE: Earnings of any recipient or minor parent head of household approved for an extension due to a total inability to work shall cause case closure due to failure to meet extension criteria, regardless of the amount of the earnings.
If, during the extension period, the adult recipient or minor parent head of household fails, without good cause, to follow through on requirements established for receipt of the additional months of TANF/PaS, the Department shall withdraw the extension and terminate TANF/PaS benefits. See “End of a Hardship Extension,” below.
v. End of a Hardship Extension:
All hardship extensions are temporary and may be approved for up to six months. During the hardship extension period the ASPIRE worker shall monitor the case for compliance. The TANF/PaS benefit continues until the extension ends or the family is no longer eligible for TANF/PaS for other reasons.
The Department shall provide the family with notice, which shall be consistent with the notice described under Pre-Termination Notice and Conference (see Ch. I, J(3)(h)), at least ten days before the end of the hardship extension. That notice must include an explanation of the right to request a hearing.
A hardship extension ends when—
The extension period has expired: If, at the time of expiration, the adult, or minor parent head of household, recipient has not resolved the situation that led to the extension, the adult recipient may request a subsequent extension. The adult recipient must present documentation that verifies the need for the extension. The Department shall make a decision whether to grant a subsequent extension prior to the TANF/PaS closure;
The situation causing the need for a hardship extension has been resolved and the reason for the extension no longer exists. The adult, or minor parent head of household, recipient may request an extension based on other criteria, if it exists, at that time. The Department shall make a decision whether to grant a subsequent extension prior to the TANF/PaS closure; or
The adult recipient or minor parent head of household, without good cause, fails to cooperate with their Family Contract Amendment, DSER or QC, during the temporary hardship extension period.
d. Pre-Termination Conference at the End of a Hardship Extension:
A recipient whose hardship extension is ending may request a pre-termination conference to contest the Department’s calculation of the end of the extension or to seek to establish the family’s eligibility for a continued extension. This conference shall be consistent with the process described under Pre-Termination Notice and Conference (see Ch. I, J(3)(h)), with the exception of the timeframe. If a pre-termination conference is requested within ten days of the date of the written notice of the end of a temporary hardship extension, the family’s benefits continue until the conference has been held and a determination made, or until the scheduled termination date, whichever occurs later.
vi. Good Cause:
Good cause for non-compliance with an activity in the Family Contract during a hardship extension is allowed consistent with the good cause provisions of ASPIRE-TANF explained in Chapter II(H)(4).
If good cause is found, the individual is allowed to continue receiving benefits and must demonstrate compliance with the Family Contract Amendment.
vii. Right to Appeal:
Any adult, or minor parent head of household, recipient whose request for a hardship extension has been denied for any reason may request an Administrative Hearing. Benefits, however, may not be extended beyond the 60th month or be reopened following a 60-month closure while a hearing or a decision by the Hearings Officer is pending. All other rules regarding the Administrative Hearing procedures outlined in Chapter VI apply.
When the Hearing Officer decides that the Department was not correct in its action, the Department shall make a corrective payment, based on all eligibility factors, for the period specified in the hearing decision.
AGE: For a family to be eligible for TANF/PaS, the specified relative, and the dependent child(ren) must meet the requirements of this section.
Specified Relative: The specified relative must be 18 years of age or older unless they meet the maintenance of a home requirements for minor parents. (See E(3)(b)).
Dependent Child: The dependent child must be:
Under the age of 18; or
Aged 18 and enrolled as a full-time student in a high school or an equivalent instruction alternative, leading to a high school diploma.
When the student who is the dependent child on the TANF/PaS grant becomes 19, they are not eligible for the federally funded TANF program. They may receive state funded cash assistance until they graduate or become 21 years old, whichever comes first.
RESIDENCE
All recipients must be living in Maine voluntarily with the intent to make Maine their home.
CITIZENSHIP
NOTE: Unless specified otherwise, all references to the United States Code (U.S.C.) reference the version most currently in effect. The text of these laws can be found at https://uscode.house.gov/. Individuals may also request copies by writing to:
Rules Manager
Maine DHHS, Office for Family Independence
11 State House Station
109 Capitol St., Augusta, ME 04333-0011
1. General Rule
Only U.S. citizens and certain noncitizens are eligible for benefits. The presence of an ineligible noncitizen or individual with unverified status does not prohibit the remaining members of the household from being eligible.
b) Citizenship or noncitizen status must be verified for each household member seeking benefits.
2. CITIZENS AND U.S. NATIONALS
a) The following individuals are potentially eligible for federally funded benefits:
i. Individuals born in one of the 50 states, the District of Columbia, Puerto Rico, Guam, the U.S. Virgin Islands, the Northern Mariana Islands (NMI), American Samoa or Swain’s Island,
ii. Individuals born to one or more U.S. citizens. Individuals adopted by one or more U.S. citizens and residing in the United States prior to reaching the age of 16, and
iii. Individuals who have been lawfully naturalized per 8 U.S.C. §§ 1421 and 1448.
a) Acceptable verification of U.S. citizen or a U.S. national status is listed below. Verification from one list is only acceptable if no verification from any preceding list is available. In the absence of an item from List A (Subparagraph i below) separate verification from List B (Subparagraph ii) must be provided. In the absence of items from both Lists A and B, all verifications from List C (Subparagraph iii) must be provided.
List A includes-
A data match showing U.S. citizenship or U.S. national status with a state or national database such as-
the State Data Exchange (SDX),
the Beneficiary and Earnings Data Exchange (BENDEX),
the State Verification and Exchange System (SVES); or
the Systemic Alien Verification for Entitlements (SAVE) system;
b. A U.S. public birth certificate showing birth in one of the 50 States, the District of Columbia, Puerto Rico (if born on or after January 13, 1941), Guam, the Virgin Islands of the U.S., American Samoa, Swain’s Island, or the Northern Mariana Islands (after November 4, 1986 (NMI local time)). The birth record document may be issued by the state, commonwealth, territory or local jurisdiction. It must have been recorded before the person was 5 years of age.
If the document shows the individual was born in Puerto Rico, Guam, the Virgin Islands of the U.S., or the Northern Mariana Islands before these areas became part of the U.S., see Subparagraph iii below.
c. A U.S. passport, including U.S. passport card: a U.S. passport need not be currently valid to be accepted as evidence of U.S. citizenship as long as the passport was initially issued for the full validity period based on the persons age and for a period of five years or more. An expired passport that was initially issued less than the full validity period based on the persons age may be used as proof of identity only.
d. A Report of Birth Abroad of a U.S. Citizen issued by the U.S. Department of State;
e. A Certification of Report of Birth issued by the U.S. Department of State;
f. A Certificate of Naturalization issued by the U.S. Department of Homeland Security (DHS) or its predecessors;
g. A Certificate of U.S. Citizenship issued by the U.S. Department of Homeland Security (DHS) or its predecessors;
h. A U.S. Citizen I.D. Card issued by DHS or its predecessors;
i. A Northern Mariana Identification Card issued by DHS or its predecessors; or
j. An American Indian Card issued by DHS or its predecessors with the classification code “KIC" and a statement on the back denoting U.S. citizenship.
ii List B includes –
a. A religious record recorded in the U.S. within three months of birth showing the birth occurred in the U.S. and showing either the date of the birth or the individual’s age at the time the record was made. The record must be an official record recorded with a religious organization. (Entries in a family bible, for example, are not considered religious records.);
b. A document showing employment by the U.S. government before June 1, 1976;
c. Early school record showing a U.S. place of birth. The school record must show the name of the child, the date of the admission to the school, the date of the birth, a U.S. place of birth, and the name(s) and place(s) of the birth of the applicant’s parents;
d. A federal or state census record showing U.S. citizenship or a U.S. place of birth and the individual’s age or date of birth;
e. One of the following documents that show a U.S. place of birth;
1. Seneca Indian tribal census record;
2. Bureau of Indian Affairs tribal census records of the Navajo Indians;
3. U.S. State Vital Statistics official notification of birth registration;
4. A delayed U.S. public birth record that is recorded more than five years after the person’s birth;
5. Statement signed by a physician or midwife who as in attendance at the time of birth; or
6. Bureau of Indian Affairs Roll of Alaska Natives.
f. A final adoption decree showing the child’s name and U.S. place of birth;
g. In situations where an adoption is not finalized and the state in which the child was born will not release a birth certificate prior to a final adoption, a statement from a state approved adoption agency that shows the child’s name and U.S. place of birth. The adoption agency must state in the certification that the source of the place of birth information is an original birth certificate;
h. A U.S. Military Record showing a U.S. place of birth;
i. An extract of a hospital record on hospital letterhead, indicating a U.S. place of birth. The hospital record must have been established at the time of the person’s birth and created at least five years before the initial application date for TANF. A souvenir “birth certificate” issued by a hospital does not satisfy this requirement;
j. A life, health, or other insurance record showing a U.S. place of birth. The record must have been created at least five years before the initial application date for TANF;
k. Medical (clinic, doctor, or hospital) record showing a U.S. place of birth created at least five years before the initial application date for TANF. (For children under the age of 16, the document must have been created near the time of birth or five years before the date of application.) An immunization record alone is not considered a medical record for purposes of establishing U.S. citizenship.
l. A public birth certificate showing birth in Puerto Rico, prior to January 13, 1941, U.S. Virgin Islands June 28, 1932, Northern Mariana Islands (NMI) or Trust Territory of the Pacific Islands (TTPI) November 5, 1986. The birth record document may be issued by the state, commonwealth, territory or local jurisdiction. It must have been recorded before the person was 5 years of age.
m. For individuals born in Puerto Rico prior to January 13, 1941
1. Evidence of birth in Puerto Rico and the person’s statement that were residing in the U.S., a U.S. possession, or Puerto Rico on January 13, 1941; or
2. Evidence that the person was a Puerto Rican citizen and the person’s statement that they were residing in Puerto Rico on March 1, 1917 and that they did not take an oath of allegiance to Spain.
n. For individuals born in the U.S. Virgin Islands prior to June 28, 1932
1. Evidence of birth in the U.S. Virgin Islands, and the person’s statement of residence in the U.S., a U.S. possession or the U.S. Virgin Islands on February 25, 1927;
2. The person’s statement indicating residence in the U.S. Virgin Islands as a Danish citizen on January 17, 1917 and residence in the U.S., a U.S. possession, or the U.S. Virgin Islands on February 25, 1927, and that the person did not make a declaration to maintain Danish citizenship; or
3. Evidence of birth in the U.S. Virgin Islands and the person’s statement indicating residence in the U.S., a U.S. possession, or Territory or the Canal Zone on June 28, 1932.
o. Northern Mariana Islands (NMI) (formerly part of the Trust Territory of the Pacific Islands {TTPI}):
1. Evidence of birth in the NMI, TTPI citizenship and residence in the NMI, the U.S., or a U.S. Territory or possession on November 3, 1986 (NMI local time) and the person’s statement that they did not owe allegiance to a foreign state on November 4, 1986 (NMI local time);
2. Evidence of TTPI citizenship, continuous residence in the NMI since before November 3, 1981 (NMI local time), voter registration prior to January 1, 1975 and the person’s statement that they did not owe allegiance to a foreign state on November 4, 1986 (NMI local time); or
3. Evidence of continuous domicile in the NMI since before January 1, 1974 and the applicant’s statement that they did not owe allegiance to a foreign state on November 4, 1986 (NMI local time).
If an individual entered the NMI as a nonimmigrant and lived in the NMI since January 1, 1974, this does not constitute continuous domicile and the person is not a U.S. citizen.
p. Evidence, from list A above, of the U.S. citizenship of the individual’s parents, evidence of the relationship of the individual to the parents, and evidence that at least one parent resided in the U.S. or an outlying possession prior to the individual’s birth;
q. Evidence, from list A above, that one of the individual’s parents is a U.S. citizen and that the other is a U.S. citizen parent, and evidence that the U.S. citizen parent resided in the U.S., a U.S. possession, American Samoa or Swain’s Island for a period of at least one year prior to the applicant’s birth.
r. Evidence, from list A above, of the U.S. citizenship of the individual’s mother, evidence of the relationship to the applicant and-
1. For births on or before December 24, 1952, evidence that the mother resided in the U.S. prior to the applicant’s birth, or
2. For births after December 24, 1952, evidence that the mother had resided, prior to the child’s birth, in the U.S. or a U.S. possession for a period of one year.
s. A birth certificate showing birth in the Canal Zone on or after February 26, 1904 and before October1, 1979 and evidence, from list A above, that one parent was a U.S. citizen at the time of the individual’s birth;
t. A birth certificate showing birth in the Republic of Panama on or after February 26, 1904 and before October 1, 1979 and evidence, from list A above, that at least one parent was a U.S. citizen and evidence that the parent was employed by the U.S. government or the Panama Railroad Company or its successor in title.
u. A marriage license showing marriage prior to September 22, 1922, and evidence, from list A above that the spouse was a U.S. citizen.
v. Institutional admission papers from a nursing facility, skilled care facility or other institution, showing a U.S. place of birth, created at least five years before the initial application for TANF.
iii. List C includes-
In the absence of any of the above verifications, all of the following must be provided:
a. A written affidavit of citizenship signed, under penalty of perjury, from a third party indicating a reasonable basis for personal knowledge that the member in question is a U.S. citizen or non-citizen national. The signed statement must acknowledge that the individual signing the affidavit recognizes that providing a false statement may result in penalties including disqualification from Public Assistance and Supplemental Nutrition Assistance Programs, and criminal penalties including a fine of $500 and 11 months of imprisonment.
b. Verification of the identity of the third party who signed the affidavit from List A above.
c. Verification of the citizenship or noncitizen national status of the third party who signed the affidavit from List A above; and
d. An affidavit signed by the individual, their guardian, or their authorized representative explaining why no verification from List A through B above exist or can be obtained.
3. INDIVIDUALS WHO ARE NOT U.S. CITIZENS OR NATIONALS BUT ARE POTENTIALLY ELIGIBLE FOR FEDERALLY FUNDED TANF/PaS
a) Acceptable Verification
i. A data match with the United States Department of Homeland Security (DHS) is the controlling verification type. Should there be a discrepancy between this data match and the status attested to by the individual the Department shall-
Use the status verified through the data match for all eligibility determinations; and
Provide the individual with contact information to resolve the conflict with DHS.
ii. In instances that a particular status type cannot be verified through a data match with DHS, “Supplemental Verifications” may be provided to aid in the data match verification process. All requests for verification will be made in writing in accordance with the “Verification and Documentation” standards as defined in Chapter I, Section D (5).
a. Supplemental Verification serves two purposes:
1. These documents may aid the Department in securing required data matches.
2. In instances where a response from DHS indicates that DHS cannot yet provide a definitive result due to a technical error, the Department shall honor the attested to status on the supplemental verification until such time that a data match response is received from DHS.
b. Unless detailed otherwise within the type below, Supplemental Verification is the most current version of a letter or other document from DHS that includes-
1. a statement that the individual has been granted a noncitizen status,
2. this individual’s full name, and
3. at least one of the following:
(a) the individual’s social security number,
(b) the individual’s immigration related A-Number,
(c) the individual's passport number, or
(d) the individual's date of birth.
b) Individuals with the following non-citizen types are potentially eligible for federally funded benefits
i. North American indigenous people born in Canada.
a. Description
Individuals born in Canada who have at least 50% of their racial heritage from North American indigenous peoples.
b. Special Conditions
Individuals who have this status, who are not considered U.S nationals and who began their residency in the U.S. on or after August 22, 1996 are subject to a 5 year waiting period from their initial date of residency; or meet one or more of the special conditions detailed in the “Special Conditions for Federally Funded TANF/PaS” in Paragraph c below.
c. Supplemental Verification of this type is a Ketchikan Indian Community (KIC) American Indian Card.
ii. Refugees
a. Description
1. Individuals granted and retaining refugee status pursuant to 8 U.S.C. § 1157; or
2. Individuals who were granted refugee status and did not have it terminated pursuant to 8 U.S.C. § 1157 who now have a different status such as Lawful Permanent Resident.
b. Special Conditions
Individuals who have been granted this status and have not had it terminated pursuant to 8 U.S.C. § 1157 have no waiting period or other conditions described in this section to receive benefits, even if they currently hold a different status.
iii. Asylees
a. Description
1. Individuals granted and retaining asylum pursuant to 8 U.S.C. § 1158 or
2. Individuals who were granted asylum and did not have it terminated pursuant to 8 U.S.C. § 1158 who now have a different status such as Lawful Permanent Resident.
b. Special Conditions
Individuals who have been granted this status and have not had it terminated pursuant to 8 U.S.C. § 1158 have no waiting period or other conditions described in this section to receive benefits, even if they currently hold a different status.
iv. Deportees whose deportation is withheld
Description
Individuals who are not being deported because they meet the conditions of—
1. 8 U.S.C. § 1231(b)(3) or
2. 8 U.S.C. § 1253(a)(3).
b. Special Conditions
Individuals who have been granted this status and have not had it terminated, have no waiting period or other conditions described in this section to receive benefits.
v. Cuban and Haitian Entrants
a. Description
1. Individuals granted and retaining Cuban and Haitian entrant status as defined in the notes of 8 U.S.C. § 1641.
2. Individuals who were granted Cuban and Haitian entrant status as defined in the notes of 8 U.S.C. § 1641 and did not have it terminated who now have a different status such as Lawful Permanent Resident.
b. Special Conditions
Individuals who have been granted this status and have not had it terminated have no waiting period or other conditions described in this section to receive benefits, even if they currently hold a different status.
c. Additional Supplemental Verification
To aid in the verification process, individuals with this non-citizenship status are encouraged to provide—
1. Both—
(a) a Cuban or Haitian Passport or birth certificate and
(b) the most current version of a letter or other document from DHS stating that they have received an application for asylum or a document showing a future court date concerning removal for the individual that contains the individual’s full name and at least one of the following:
(i) the individual’s social security number,
(ii) the individual’s immigration related A-Number,
(iii) the individual’s passport number, or
(iv) the individual’s date of birth.
vi. Certain Amerasian Immigrants
a. Description
1. Individuals granted and retaining lawful presence in the United States per the Amerasian Immigration conditions defined in the notes of 8 U.S.C. § 1101.
2. Individuals who were granted lawful presence in the United States per the Amerasian Immigrations conditions defined in the notes of 8 U.S.C. § 1101 and did not have it terminated who now have a different status such as Lawful Permanent Resident.
b. Special Conditions
Individuals who have been granted this status and have not had it terminated are not subject to a five year waiting period or other conditions described in this section to receive benefits, even if they currently hold a different status.
vii. Iraqi Special Immigrants
a. Description
1. Individuals granted and retaining Special Immigrant Status for Certain Iraqis defined in the notes of 8 U.S.C. § 1157.
2. Individuals who were granted Special Immigrant Status for Certain Iraqis as defined in the notes of 8 U.S.C. § 1157 and did not have it terminated who now have a different status such as Lawful Permanent Resident.
b. Special Conditions
Individuals who have been granted this status and have not had it terminated are not subject to a five year waiting period or other conditions described in this section to receive benefits, even if they currently hold a different status.
viii. Afghan Special Immigrants
a. Description
1. Individuals granted and retaining Special Immigrant Status for Certain Afghans as defined in the notes of 8 U.S.C. § 1157.
2. Individuals who were granted Special Immigrant Status for Certain Afghans and did not have it terminated who now have a different status such as Lawful Permanent Resident.
b. Special Conditions
Individuals who have been granted this status and have not had it terminated are not subject to a five year waiting period or other conditions described in this section to receive benefits, even if they currently hold a different status.
ix. Afghan Humanitarian Parolees
a. Description
Individuals granted Afghan humanitarian parole between July 31, 2021 and September 30, 2023.
b. Special Conditions
Individuals who have been granted this status and have not had it terminated are not subject to a five year waiting period.
Unless they move to another qualifying status, individuals who are eligible based on this status lose eligibility the later of
1. March 31, 2023 or
2. the end of their parole term.
x. Certain Hmong and Highland Laotians
NOTE: Most individuals who would be eligible in this category are also eligible as Refugees (See Subparagraph ii above).
a. Description
1. Individuals lawfully residing in the U.S. who were a tribal member of a Hmong or Highland Laotian tribe at the time the tribe assisted the U.S. in a military or rescue operation between August 5, 1964 and May 7, 1975, or
2. The spouse and/or unmarried dependent children of an individual described in 1 above, or
3. The unmarried, surviving spouse and dependent children of a deceased person described in 1 above except that the tribal member does not have to be lawfully residing in the U.S.
b. Special Conditions
Individuals who have this status, who are not considered U.S nationals and who began their residency in the U.S. on or after August 22, 1996 are subject to a 5 year waiting period from their initial date of residency; or meet one or more of the special conditions detailed in the “Special Conditions for Federally Funded TANF/PaS” in Paragraph c below.
c. Additional Supplemental Verification—
1. For the tribal member
(a) A data match with the United States Department of Homeland Security (DHS) showing—
(i) A lawful presence;
(ii) A date of birth prior to May 8, 1975;
(iii) A country of birth of Laos, Thailand, Cambodia, China, Vietnam, The Philippines, Indonesia, Hong Kong, Malaysia, or Singapore; and
(iv) A land date after March 1975.
If the land date is prior to April 1975, the standard is still met if the individual was in the U.S. as a student, for military training, to escape the war, or some similar purpose.
and
(b) Their name is listed on the Refugee Data Center list, or
(c) If they cannot be found on the Refugee Data Center list an affidavit signed by the tribal member or, if they are deceased, their surviving spouse or child swearing under the penalty of law that the individual was a member of a Hmong or Highland Laotian tribe between August 5, 1964 and May 7, 1975.
2. For the current or surviving spouse, or dependent child
(a) verification of the eligibility of a tribal member as detailed in 1 above, and
(b) verification of the relationship to the tribal member such as a birth certificate, marriage license or tax records.
xi. Individuals who have been subject to severe forms of trafficking, their spouses, minor children, parents, and siblings
a. Description
1. Individuals meeting the definition of “victim of a severe form of trafficking in persons” as defined at 22 U.S.C. § 7105(b)(1)(C) or meeting all but the age requirement, and
2. The spouse, minor child, parent or sibling of such an individual who holds a T Visa.
b. Special Conditions
Individuals who have been granted this status and have not had it terminated are not subject to a five year waiting period or other conditions described in this section to receive benefits, even if they currently hold a different status.
c. Additional Acceptable Verification of this type is—
Verification through the trafficking victims’ verification toll-free number, (866) 401-5510.
xii. Certain individuals who have been battered and certain relatives of theirs
a. Description
1. Individuals granted and retaining immigrant status under the conditions of 8 U.S.C. § 1154(a)(1)(A)(iii), (iv), (v)(I)(cc), (vii) or 1154(a)(1)(B)(ii), (iii), or (iv)(I)(cc).
2. Individuals granted immigrant status under the conditions of 8 U.S.C. § 1154(a)(1)(A)(iii), (iv), (v)(I)(cc), (vii) or 1154(a)(1)(B)(ii), (iii) or (iv)(I)(cc) who did not have it terminated and now have a different status such as Lawful Permanent Resident.
NOTE: Generally speaking, these are spouses and children of individuals lawfully in the U.S. who were battered while in the U.S. or are the parent or unmarried child of the battered individual. They must not be currently residing with the batterer.
b. Special Conditions
To be potentially eligible for federally funded benefits these individuals must, also meet one or more of the special conditions detailed in the “Special Conditions for Federally Funded TANF/PaS” in Paragraph c below.
c. Additional Acceptable Verification of this type is—
1. A letter or other document from DHS, a court, or a law enforcement agency demonstrating a substantial likelihood that the individual, their parent, or a family member there of that contains the individual’s full name and at least one of the following:
(a) the individual’s social security number,
(b) the individual’s immigration related A-Number,
(c) the individual’s passport number, or
(d) The individual’s date of birth.
And
2. A data match with the United States Department of Homeland Security (DHS) showing a lawful presence.
xiii. Certain individuals who have been lawfully admitted for permanent residence
a. Description
Individuals meeting the definition of “lawfully admitted for permanent residence” as defined at 8 U.S.C. § 1101(a)(20).
b. Special Conditions
To be potentially eligible for federally funded benefits these individuals must, also meet one or more of the special conditions detailed in the “Special Conditions for Federally Funded TANF/PaS” in Paragraph c below.
xiv. Certain individuals who have been paroled into the U.S. for at least one year for urgent humanitarian reasons or significant public benefit.
a. Description
Individuals granted, for at least one year, and currently retaining immigrant status under the conditions of 8 U.S.C. § 1182(d)(5).
b. Special Conditions
To be potentially eligible for federally funded benefits these individuals must, also meet one or more of the special conditions detailed in the “Special Conditions for Federally Funded TANF/PaS” in Paragraph c below.
xv. Certain individuals who were granted conditional entrance prior to April 1, 1980
a. Description
Individuals granted conditional entrance per 8 U.S.C. § 1153(a)(7) as it was in effect May 31, 1980. The text of this law can be found at https://uscode.house.gov/statviewer.htm?volume=79&page=912#.
Individuals may also request copies by writing to:
Rules Manager
Maine DHHS, Office for Family Independence
11 State House Station
109 Capitol St.
Augusta, ME 04333-0011
b. Special Conditions
To be potentially eligible for federally funded benefits these individuals must, also meet one or more of the special conditions detailed in the “Special Conditions for Federally Funded TANF/PaS” in Paragraph c below.
c. Acceptable Verification of this type is a data match with the United States Department of Homeland Security (DHS) showing conditional entrance granted prior to April 1, 1980.
xvi. Citizens of countries governed by the Compacts of Free Association (COFA)
a. Description
1. Individuals who reside lawfully in the United States in accordance with section 141 of the Compacts of Free Association between the Government of the United States and the Governments of the Federated States of Micronesia, the
Republic of the Marshall Islands, and the Republic of Palau, as amended by the Consolidated Appropriations Act of 2024, Public Law 118-42.
2. Individuals who were granted COFA status and did not have it terminated pursuant to 8 U.S.C. § 1641 who now have a different status such as Lawful Permanent Resident.
b. Special Conditions
Individuals who have been granted this status and have not had it terminated pursuant to 8 U.S.C. § 1641 as amended by the Consolidated Appropriations Act of 2024, Public Law 118-42, have no waiting period or other conditions described in this section to receive benefits.
c) Special Conditions for Federally Funded TANF/PaS
In addition to the requirements of Paragraph b, above, at least one of the following special circumstances must be met for some individuals (as indicated in their “Special Conditions” above) to be potentially eligible for federally funded TANF/PaS:
i. The individual has been continually present in the U.S. with the latest date of entry being prior to August 22, 1996.
ii. The individual has lived in the U.S. for a period of 5 years from the date of entry occurring on or after August 22, 1996.
iii. The individual is a veteran of or on active duty in the United States Armed Forces or is the spouse or unmarried dependent child of a veteran or active service member.
Acceptable verification of this condition is:
a. Documents from the applicable branch of the Armed Services showing current active duty status, other than training, that contains the service member’s full name and either their date of birth or social security number; or
b. Documents from the Veteran’s Administration showing veteran status that contains the veteran’s full name and either their date of birth or social security number, with a discharge characterized as an honorable discharge and not on account of citizenship status.
c. Verification that an individual meets this condition based on being the spouse or dependent child of the service member or veteran is—
1. Documents from the applicable branch of the Armed Services or Veteran’s Administration showing eligibility for military or veterans benefits as a child or spouse that contains the individual’s full name and either their date of birth or social security number; or
2. The verifications detailed in (a) or (b) above, and
(a) For a spouse, a marriage license naming the service member or veteran as the individual’s spouse, or
(b) For a dependent child a birth certificate or adoption record naming the service member or veteran as the individual’s parent and school records naming the individual as a current student.
or
iv. The individual has 40 qualifying quarters of work.
a. This condition must be verified through a data match with the Social Security Administration (SSA).
b. If the initial data match does not show 40 qualifying quarters, the individual states they have 40 qualifying quarters, and the individual is otherwise eligible, the Department shall issue federally funded benefits for up to six months while the individual works with the SSA to rectify the count. If, after six months a data match with the SSA still does not show 40 qualifying quarters, the household will be responsible for repaying the benefits issued in error.
NOTE: quarters attributed from a spouse cannot be counted if the individual divorced the spouse prior to the most recent certification for TANF/PaS.
4. INDIVIDUALS WHO ARE NOT U.S. CITIZENS OR NATIONALS BUT ARE POTENTIALLY ELIGIBLE FOR STATE FUNDED TANF/PaS
An individual who is not a citizen or national of the United States must present proof of immigration registration from the U.S. Citizenship and Immigration Services (USCIS), Department of Justice (DOJ) or other documents indicating the individual's qualifying noncitizen status.
a) Acceptable Verification
i. A data match with the United States Department of Homeland Security (DHS) or electronic verification through the Department of Justice (DOJ), Executive Office for
Immigration Review (EOIR) are the controlling verification types. Should there be a discrepancy between the data match and the status attested to by the individual. The Department shall—
a. Use the status verified through the data match for all eligibility determinations; and
b. Provide the individual with contact information to resolve the conflict with DHS.
ii. In instances that a particular status type cannot be verified through a data match with DHS or DOJ, “Supplemental Verifications” may be provided to aid in the data match verification process. All requests for verification will be made in writing in accordance with the “Verification and Documentation” standards as defined in Chapter I, Section D (5).
a. Supplemental Verification serves two purposes:
1. These documents may aid the Department in securing required data matches.
2. In instances where a response from DHS indicates that DHS cannot yet provide a definitive result due to technical error, the Department shall honor the attested to status on the supplemental verification until such time that a data match response is received from DHS or DOJ.
b. Unless detailed otherwise within the type below, Supplemental Verification is the most current version of a letter or other document from DHS, DOJ or a signed affidavit from an attorney that includes-
1. a statement that the individual has applied for or been granted a noncitizen status,
2. this individual’s full name, and
3. at least one of the following:
(a) the individual’s social security number,
(b) the individual’s immigration related A-Number,
(c) the individual's passport number, or
(d) the individual's date of birth.
b) Individuals with the following non-citizen types are potentially eligible for state funded TANF/PaS:
i. Any individual with a non-citizen type as described in Subsection 3(b)(xii) through (xv) above except that they do not meet the “Special Conditions for Federally Funded TANF/PaS” described in Subsection 3(c) above.
To be potentially eligible for state funded benefits these individuals must, also meet one or more of the conditions detailed in the “Special Conditions for State Funded TANF/PaS” in Paragraph c below.
ii. Certain asylum seekers
a. Description
Individuals who have filed an application for asylum and for withholding of removal with DHS or DOJ.
b. Special Conditions
To be potentially eligible for state funded benefits these individuals must, also meet one or more of the special conditions detailed in the “Special Conditions for State Funded TANF/PaS” in Paragraph c below.
iii. Certain individuals with temporary protected status
a. Description
Individuals who have been granted and retain temporary protected status per 8 U.S.C. § 1254(a).
b. Special Conditions
To be potentially eligible for state funded benefits these individuals must, also meet one or more of the special conditions detailed in the “Special Conditions for State Funded TANF/PaS” in Paragraph c below.
c) Special Conditions for State Funded TANF/PaS
In addition to the requirements of Paragraph b, above, at least one of the following special circumstances must be met for individuals to be potentially eligible for state funded TANF/PaS (as indicated in their “Special Conditions” above):
i. The individual is 65 years of age or older as evidenced by any government issued document.
ii. The individual has a disabling condition
a. Description
The individual meets the definition of blind or disabled per 42 U.S.C. § 1382(c).
b. Acceptable verification of this condition is—
1. The individual receiving disability related cash or medical assistance from OFI,
2. A data match with the Social Security Administration (SSA) showing the individual is receiving disability related cash or medical assistance from them,
3. A letter or other document from SSA showing the individual is eligible for disability related medical or cash assistance, or a favorable disability determination that is dated within the past 90 days and includes the individual’s full name and either their date of birth or social security number; or
4. A favorable disability determination from Maine’s Medical Review Team.
iii. The individual or their parent cannot legally work due to a required waiting period.
a. Description
1. The individual is subject to and within a required waiting period before they can apply for an Employment Authorization Document (EAD),
2. The individual is eligible for an EAD and has applied for it, but has not received it, or
3. The individual is under 18 years of age and one or more of their parents in their household meets (1) or (2) above.
b. Acceptable verification of this condition is—
1. A data match with DHS or EOIR showing that the individual is subject to and within a waiting period to apply for an EAD;
2. A data match with DHS showing that the individual has applied for Employment Authorization, but it has not yet been approved; or
3. Verification that the individual is an asylum seeker (See Paragraph b(ii)(c) of this Subsection) and that same verification shows that the application was received recently enough that the individual is still within the waiting period to apply for an EAD.
4. For a child under 18 years of age verification also includes either—
(a) a birth certificate or adoption record naming the person verified as eligible as the individual’s parent, or
(b) a signed affidavit from the person verified as eligible that the child is theirs.
iv. The individual or their parent was issued an EAD but is currently unemployed
a. Description
1. The individual was issued an EAD but has not found employment;
2. The individual was issued an EAD and lost all forms or employment; or
3. The individual is under 18 year of age and one or more of their parents in the household fits (1) or (2) above.
b. Acceptable verification of this condition is verification of the end of any known employment consistent with Chapter I, Section D(5)(a) and Chapter IV, Section E(1), and—
1. Prior information in the OFI system that the individual received EAD, or
2. A data match with DHS showing that the individual received an EAD.
3. For a child under 18 years of age verification also includes either—
(a) a birth certificate or adoption record naming the person verified as eligible as the individual’s parent, or
(b) a signed affidavit from the person verified as eligible that the child is theirs.
v. The individual’s household is experiencing the effects of domestic violence
a. Description
One or more members of the household are dealing with the effects of domestic violence including—
1. Physical acts/threats of physical injury,
2. Sexual abuse or assault of a child or caretaker of a child, or
3. Psychological effects of the abuse.
b. Acceptable verification of this condition is a letter or other document that indicates the household member is experiencing domestic violence or the effect thereof from:
(a) DHS,
(b) a court,
(c) a law enforcement agency,
(d) a governmental child or adult protective agency,
(e) a licensed social worker,
(f) a medical professional, or
(g) A sworn statement from the applicant or recipient may be provided, or a department issued form can be completed, attesting to the circumstances that provide the basis for the exception. Supporting documentation may be required if articulable doubt exists regarding the credibility of the provided statements or forms.
5. PROCESSING PROCEDURES
a) General Rules
i. Citizenship, noncitizen status, and the special conditions described in this section must be verified at application or any time a change in these factors is reported by the household or a third party.
ii. The status of any noncitizen must, ultimately, be verified through a data match.
iii. The same Verification and Documentation, Time and Processing Standards, and Application Notification that apply to all other aspects of application or change reporting also apply to citizenship, noncitizen status, and the special conditions described in this section. These standards can be found in Chapter 1, Section D(5) through (7).
iv. Citizenship, noncitizen status and the special conditions described in this section only need to be verified for individuals attesting that such factors make them potentially eligible for benefits. Individuals who state their noncitizen status makes them ineligible do not need to have their status verified. Other information, such as their income or assets may need to be verified.
v. The presence of an ineligible member in the household does not preclude eligible members from receiving TANF/PaS. The countable portion of their income or assets may render the remaining members ineligible. (See Chapter II, Section B(1)(c) and Chapter IV, Sections A, C, D(5), and E(4)(b).)
b) Processing
i. Applicants and recipients are encouraged to provide the following at application or anytime they experience a change in citizenship or noncitizen status or special conditions described in this section:
a. a declaration of their citizenship or noncitizen status and any special conditions described in this section,
b. Their full name and date of birth (citizens naturalized after their date of birth are encouraged to provide their date of naturalization as well) and at least one of the following enumerators:
1. For citizens and noncitizen nationals—
(a) a social security number, or
(b) naturalization/citizenship number.
2. For noncitizens—
(a) an immigration related A-Number,
(b) an 1-94 number,
(c) a card/receipt number from a DHS document,
(d) a passport number from a foreign passport and the name of the issuing country,
(e) a U.S. Visa number,
(f) a Student and Exchange Visitor Information System (SEVIS) number, or
(g) Any documentation that would serve as acceptable or supplemental verification of the declared citizenship, noncitizen status or special conditions as defined in Sections 3 and 4 above for the respective declaration of status or special conditions.
ii. At initial application or a reported change in citizenship, noncitizen status or special conditions the Department shall verify that the individual has provided the items detailed in Subparagraph i above.
iii. If the individual states that they are a citizen or national of the United States the following processes apply:
a. If their status was previously verified with OFI, it is verified;
b. If they provide Acceptable Verification, their status is verified;
c. If they were not previously known to OFI and they do not provide Acceptable Verification the following processes apply:
1. If they do not provide their full name, the date they became a citizen or national, and a social security number:
(a) Their status is not verified; and
(b) The Department shall request this information and documentation in writing.
(i) If they provide documentation, their status is verified.
(ii) If they provide their full name, the date they became a citizen or national, and a social security number or naturalization/citizenship number to the steps outlined in 2 below apply.
(iii) If they do not timely provide documentation or their full name, the date they became a citizen or national, and a social security number or naturalization/citizenship number, they are ineligible for failure to provide required documentation.
2. If they provide their full name, the date they became a citizen or national, and a social security number or naturalization/citizenship number—
(a) their status is temporarily honored; and
(b) the Department shall attempt a data match to verify their status indefinitely.
(i) If the data match is successful, their status is verified.
(ii) If the data match is not successful, the Department shall request documentation from the individual in writing.
If documentation is provided, the status is verified.
If documentation is not provided timely the individual is ineligible for failure to provide required documentation.
d. If they were previously known to OFI and had declared citizenship, but it had not been verified and they do not provide documentation, the Department shall request documentation from the individual in writing.
1) If documentation is provided, the status is verified.
2) If documentation is not provided timely the individual is ineligible for failure to provide required documentation.
iv. If the individual states they are an eligible non-citizen other than a non-citizen national, the following processes apply:
a. If the only acceptable verification of their status and/or special conditions is a data match the following processes apply to those elements.
1. If the individual has not provided their name, date of birth, and at least one enumerator listed in Subparagraph i(b)(2) above, the Department shall request them and any Acceptable or Supplemental Verification in writing.
(a) If they provide at least their name, date of birth and an enumerator, the appropriate steps per 2 below apply.
(b) If they do not provide at least their name, date of birth and an enumerator timely, they are ineligible for failure to provide required verifications.
2. If the individual provides their name, date of birth, and at least one enumerator listed in Subparagraph i(b)(2) above, the Department shall attempt a data match to verify their status and special conditions.
(a) If the data match supports the declaration(s) of status and special conditions they are verified until a change is reported.
(b) If the data match with DHS does not support the declared noncitizen status or special conditions, the Department shall request documentary verification from the individual in writing (if it has not yet been provided or requested) and attempt subsequent data matches.
(i) If at any point the data match supports the declaration(s) of status and special conditions they are verified until a change is reported.
(ii) If the data match reflects the attested status and conditions but shows a subsequent change of status and/or conditions, the most recent status and conditions reflected in the data match are verified until a change is reported.
(iii) If the household refuses or fails to provide verification timely, the individual is ineligible for failure to provide required documentation.
(c) If documentary verification has been provided, the Department shall attempt a data match in a period not to exceed 7 calendar days from the date the documentary verification is received by the Department. The attested status or special conditions are honored until such time that the data match provides the Department with a response based on the documentary verification provided by the applicant. If otherwise eligible, benefits will be granted until the data match response is received.
b. Special process for declarations that must or can be verified through means other than a data match or documentation (e.g. Individuals who have been subject to severe forms of trafficking).
The Department shall attempt to secure Acceptable Verifications via phone, fax, or other methods prescribed by the verifying agency.
1. If Acceptable Verification is provided, the declaration is verified.
2. If the agency verifies that the declaration is not applicable, the lack of status or special consideration is verified.
3. If additional information is needed to secure verification, the Department shall request it and any related documentation from the individual in writing.
(a) If the necessary information is provided, the Department will attempt to secure the verification again.
(b) If the necessary information is not provided timely, the individual is ineligible for failure to provide required verification.
SOCIAL SECURITY NUMBER
All individuals applying for or receiving TANF/PaS must furnish the agency with a Social Security Number or proof of application for a Number. The Social Security Number must be furnished to the department when it has been received.
When an individual fails to apply for a Social Security Number or furnish the Number when received, the individual is not eligible. The individual’s income, assets, and needs, will be excluded.
When the individual is a stepparent, they are an “excluded stepparent” for eligibility purposes. The individual’s income, assets, and needs, will be excluded. (See Ch. III.)
When none of the children has a Social Security Number, or has not made application for one, the household is ineligible. There are no eligible children.
RELATIONSHIP AND MAINTENANCE OF A HOME
(1) In order to be eligible for TANF/PaS, a child must be living with a specified relative, as provided by subsection (a) below, and living in a home maintained by that specified relative; and both elements must be expected to continue at least 30 days beyond the date of application.
(2) Relationship:
a) Only “specified relatives,” people with the following relationships to the child, may apply for and receive assistance on behalf of the child:
i. Biological, legal, adoptive, and step- fathers, mothers, siblings, and half siblings;
a. For purposes of subsection (i), above, the legal guardian(s) of a child as well as an “Indian custodian” as defined in the Indian Child Welfare Act of 1978, 25 U.S.C. §1903 (6) are included within the category “legal” for purposes of qualifying as “specified relatives”.
b. The spouses of any of the above persons, except those detailed in subsection i (a), above, even if the marriage has been terminated by death or divorce;
ii. Biological, legal, adoptive, and step grandparents, uncles, aunts, first cousins, and the spouses thereof even if the qualifying marriage has been terminated by death or divorce (see chart in Appendix page 5);
iii. Biological, legal, adoptive, and step great and great-great grandparents, great and great-great uncle or aunt, first cousins once removed, nephews and nieces;
iv. Minor Parent: If the applicant-child’s parent is a minor, and the minor is not maintaining a home for the child according to 3 (b), below, the specified relative must be the minor parent’s adult specified relative as provided in sections a (i-iii), above, or the representative of a certified, state-approved, adult-supervised supportive living arrangement providing food, shelter, counseling, supervision, and guidance to the minor parent. A child whose minor parent is maintained by a foster care payment is not eligible for TANF/PaS if both are residing in a licensed facility. In those instances, the foster care program must provide for the child as well as the minor parent.
b) A pregnant person who has no other children who meet the non-financial requirements of TANF/PaS in her household, starting with the sixth month of pregnancy, and whose pregnancy has been verified by a medical statement that includes the expected date of birth may be eligible for an adult-only grant.
c) Children placed with specified relatives in Maine under the Interstate Compact on Placement of Children are not eligible for TANF/PaS in Maine. The out-of-state agency that placed the children in Maine continues to be responsible for those children during the placement period.
(3) Maintenance of a Home: The specified relative is maintaining a home by providing a safe and healthy environment for the child, and by assuming the responsibility for the day-to-day care of the child, regardless of pending court decisions about legal custody.
a) Shared Custody:
i. If the child lives part of the time with each parent, the parent with whom the child lives over 50% of the time must apply for the child.
ii. If the child lives 50% of the time with each parent, either parent can apply for the child but not both.
b) Minor Parent or a Pregnant Minor: A minor parent or pregnant minor is maintaining a home within the meaning of this section only if:
i. The minor parent or pregnant minor is married; or
ii. The minor parent or pregnant minor does not live with a specified relative as provided in 2 (a) above and:
a. The minor parent or pregnant minor has no living parent;
b. Neither of the minor parent or pregnant minor’s parent’s whereabouts is known;
c. Neither of the minor parent or pregnant minor’s parents will permit them to live with the parents;
d. The Department has determined that the physical or emotional health or safety of the minor parent and their child, or that of the pregnant minor, would be jeopardized if they live with the parent(s);
e. The minor parent has lived apart from their parent(s) for at least a year prior to the child’s birth; or
f. The minor parent or pregnant minor has a similar justifiable reason for not residing with either parent that has been approved by the TANF Program Manager.
Temporary absence from the home: Within five days of the date that it becomes clear to a specified relative that a child will be absent from the home for 45 days or longer, the specified relative must notify the Department of the anticipated absence of the child from the home. See (i) below. Failure to notify the Department within the specified period will result in the removal of the specified relative from the grant.
A child who is absent from the home for 45 days or longer and the child’s specified relative remain eligible for TANF/PaS under this section if the specified relative has full responsibility for the supervision and guidance of the child, maintains a home for the child during vacation, and any delegation of authority is temporary, voluntary and revocable. The child or specified relative must return home at the completion of the reason for separation unless the separation continues for a reason below, or another similar reason:
For the child to secure education when high school facilities are not available in the area of residence or when the existing facilities do not meet the child’s educational and/or social needs;
The child is residing in a private treatment center because of physical/emotional problems;
The child is attending a specialized school for children with disabilities, provided there are no services available in the child’s own community;
The child is attending a vocational or technical school, college, or university until the child’s 18th birthday;
The specified relative or child has left the home to obtain necessary medical care for an illness; or
The child has been placed in an approved voluntary foster home by the Office of Child and Family Services and the plan is that the child will return to the home and when there is no foster care payment being made for that child.
FILING UNIT
(1) Mandatory Inclusion: The parent(s), siblings, and half siblings, living in the same home as the child for whom assistance is requested must be included as members of the same filing unit. When an individual is required by the operation of this rule to be in more than one unit, the units must be consolidated. A mandatory member of the filing unit shall be excluded from the assistance group in the following circumstances. The excluded member’s income and/or assets may be considered depending on the member’s relationship to the filing unit. See Chapters III and IV for detail.
a) Recipient of Supplemental Security Income (SSI): A TANF/PaS eligible individual who is also eligible for SSI or State Supplement benefits may choose to receive one or the other but may not receive both TANF/PaS and SSI/State Supplement. If the child chooses to receive SSI/State Supplement the otherwise eligible specified relative may receive TANF/PaS.
b) Receipt of Foster Care or Adoption Assistance: A TANF/PaS eligible individual who is also eligible for a Foster Care or Adoption Assistance payment, whether from federal, state or local funds, may choose to receive either TANF/PaS or foster care or adoption assistance but may not receive both. If the child chooses to receive a foster care/adoption assistance payment, the child is not considered a member of the assistance group when determining eligibility for the remaining filing unit members. The recipient of the foster care/adoption assistance payment may be the specified relative or the child.
c) Ineligible noncitizens;
d) Individuals who have been sanctioned; Section H (3) below.
e) Individuals convicted in federal or State court of having made a fraudulent statement or representation with respect to the place of residence of the individual in order to receive assistance simultaneously from two or more states are ineligible for a period of ten years from the date of conviction;
i. This prohibition from receipt of assistance does not apply to any months following the granting of a pardon of such a conviction by the President of the United States.
Individuals fleeing to avoid prosecution, or custody or confinement after conviction, under the laws of the place from which the individual flees, for a crime, or an attempt to commit a crime, which is a felony under the laws of the place from which the individual flees;
Individuals who violate a condition of probation or parole imposed under Federal or State law;
Strikers: Individuals participating in a strike, or who are absent from work during the strike period without good cause, on the last day of the month make the entire assistance unit ineligible. Good cause reasons for absence include:
Vacation;
Illness;
Emergency that began prior to the strike and continued into the strike period, if the absent worker intends to return to work whether or not the strike continues; or
The absent worker can prove that return to work would jeopardize their health and safety.
(2) Optional Inclusion: The following household members may choose to be included in the filing unit, but are not required to be:
a) Specified relatives and their spouses who are not parents of the dependent child. When specified relatives are excluded but claim the children as dependents for income tax purposes, they have acknowledged that they meet at least half of the child’s needs. The benefit level will be determined using half of the appropriate full need standard for the child as countable unearned income.
b) Stepparents and stepsiblings if there is not a mutual child living in the same home, requiring consolidation under subsection 1), above.
c) Household members who choose to be included in the filing unit are subject to the ASPIRE-TANF requirements of Section H., below, to the same extent as if they were mandatory filing unit members.
ESTABLISHING PATERNITY AND ASSIGNMENT OF RIGHTS TO SUPPORT
(1) If there is a noncustodial parent, all applicants or recipients must cooperate with the Department in:
a) Identifying and locating the non-custodial parent, and
b) Establishing paternity, and
c) Obtaining support or any other payments, and
d) Must assign to the Department all rights of support on behalf of filing unit members from any legally responsible relative who is absent from the home. This includes any support accrued at the time of the assignment.
(2) As a condition of eligibility, the specified relative must forward to the Department any alimony or child support payments received from the non-custodial parent, beginning the date of the first regular TANF/PaS benefit.
(3) If an applicant or recipient specified relative fails to cooperate with the requirements of this section, the specified relative will be removed from the TANF/PaS grant, and the grant amount will be reduced by the assessed needs of the specified relative or 25% of the grant amount, whichever is greater.
a) If a sanction is applied under this section, eligibility will be determined for the remaining filing unit members, and the TANF/PaS payment will be made to a third party. If there is no appropriate person to act as payee, the payment will continue to be issued to the sanctioned specified relative. The sanction remains in place until the individual complies.
b) Exceptions: Unless the sanction is for failure to comply with subsection 2) of this section (above), the specified relative shall be given the opportunity to claim good cause, orally or in writing, for refusing to cooperate. Good cause can be requested at any time. The Department will investigate claims of good cause per the procedures established in this subsection, and sanctions will not be applied nor benefits withheld while a good cause decision by the Department is pending.
i. Conditions for Good Cause: The following are the conditions under which Good Cause may be granted:
The child was conceived as a result of sexual assault:
Legal proceedings for adoption of the child are pending before a court:
For less than three months, the individual has been assisted by a licensed social service agency to decide whether to place the child for adoption; or
The individual or the child is a victim of domestic violence, which includes physical injuries or the psychological effects of abuse, or cooperation would result in physical or emotional harm to the child or other family member.
Evidence to support a claim of good cause: The Department will make a good cause determination without further investigation if a claim of good cause is supported with one of the following documents:
Birth certificates, medical or law enforcement records that indicate the child was conceived as a result of sexual assault;
Court documents or other records indicating that legal proceedings for adoption are pending before a court;
A written statement from a licensed social service agency showing that the applicant or recipient is being assisted in deciding whether to place the child for adoption;
Court, medical, law enforcement, child protective, social services (including domestic violence shelters), psychological, or other records indicating that a non-custodial parent or putative father might inflict physical or emotional harm on the child or specified relative; or
Sworn statements from individuals other than the applicant or recipient with knowledge of the circumstances that provide the basis for the good cause claim.
A sworn statement from the applicant or recipient may be provided or a department issued form can be completed attesting to the circumstances that provide the basis for the good cause claim. Supporting documentation may be required if articulable doubt exist regarding the credibility of the provided statements or forms.
iii. Determination of good cause will be made only if the evidence provided by the applicant/recipient and/or the investigation of the agency confirms that to cooperate may result in physical or emotional harm to one or more of the household member(s). The Department’s decision on good cause will:
Be in writing,
b. Contain the agency’s findings and basis of determination,
c. Be entered into the TANF/PaS record, and
d. Be made within 45 days, unless case record documentation indicates that the Department needs additional time because information required to verify the claim cannot be obtained within the time standard or because the claimant did not provide corroborative evidence within 20 days from the day in which the claim was made.
ASPIRE-TANF
Each TANF/PaS specified relative applicant and recipient of TANF/PaS, who is not exempt per subsection (2), below, must participate in ASPIRE and comply with the requirements of that program. Individuals who are exempt may participate on a voluntary basis, and will not be subject to sanction for failing to comply.
Exemptions: Applicants and recipients are exempt from ASPIRE participation if they satisfy one or more of the requirements of this subsection. The Department will review any previously established exemption at every recertification, as a part of the regular eligibility redetermination.
An applicant or recipient who is the only custodial parent of a child under one year of age and is personally providing care for that child, except that this exemption may be claimed for no more than a total of 12 months per custodial parent or specified relative in a lifetime. An applicant or recipient may elect not to claim the exemption, and if the recipient does not elect this exemption, they must participate in ASPIRE-TANF and comply with the requirements of the program.
Specified relatives under 20 years of age who have not completed high school or its equivalent may not claim this exemption, and they must attend courses to complete high school, with an emphasis on education in a traditional high school setting.
An applicant or recipient who is a VISTA volunteer under the federal Domestic Volunteer Service Act of 1973;
An applicant or recipient specified relative who is needed in the home to care for a disabled family member living in the household, provided that the disabled family member is not a full-time student. The need for the TANF/PaS recipient to care for the disabled family member must be verified at least annually through statements by an acceptable medical or mental health source; or
d) An applicant or recipient specified relative who receives Social Security Disability Insurance (SSDI) benefits.
Sanctions: When an individual required by this section to participate in ASPIRE has failed without good cause to participate in or comply with the regulations of the ASPIRE-TANF program, to sign the Family Contract Amendment or to abide by its provisions, to accept employment, or if the individual has voluntarily terminated employment, or voluntarily reduced earnings, the Department will apply a sanction in accordance with this section.
a) Benefits to the individual will be terminated until the failure to comply ceases. If eligible, benefits for the remainder of the family members may continue.
When both specified relatives are required to participate in ASPIRE, each must comply with ASPIRE-TANF, each will be sanctioned separately for failure to comply when called upon to participate.
Prior to a sanction, the adult recipient shall be provided an opportunity to show good cause for non-compliance. The recipient must demonstrate and verify to ASPIRE-TANF that good cause exists, and no sanction will be issued if the Department determines that the recipient had good cause for noncompliance, under the ASPIRE-TANF Program Rules.
d) Restoring Benefits: Prior to restoration of benefits, the adult(s) or minor parent head(s) of household must sign a new Family Contract Amendment and verify compliance with the provisions of that contract. The Department must also verify compliance with ASPIRE before closing the sanction. Benefits will be reinstated when the sanction is closed.
e) The beginning date of a sanction is the date that the Department issues the notice of adverse action.
(4) Good Cause for failure to comply with ASPIRE-TANF rules include the following:
a) Illness or advanced age of the participant, or illness or incapacity of a household member that requires the participant to provide care in the home. Verification by a physician may be required.
b) Court-required appearance or incarceration.
c) A crisis, special circumstances, or other reason that the Department determines to be Good Cause that causes an individual to be absent from or discontinue a Department activity, about which the Department has been advised, including lack of transportation or childcare necessary for participation when the individual does not have a reasonable alternative to enable the individual to participate.
If an individual has access to transportation that is reasonable under the circumstances through any program at the Department, the individual is ineligible to receive Good Cause based on lack of transportation.
d) Inability to participate due to domestic violence when the individual is unable to participate because of physical injuries or the psychological effects of abuse; because of legal proceedings, counseling or other activities related to abuse; because the abuser actively interferes with the individual’s participation; because the location puts the individual at risk; or for other Good Cause related to domestic violence. Reasonable and verifiable evidence may include, but is not limited to, the following:
i. court, medical, law enforcement, child protective, social services, psychological or other records that establish that the individual has been the victim of domestic violence; or
ii. sworn statements from persons other than the individual with knowledge of the circumstances affecting the individual; or
iii. visual observation by ASPIRE-TANF staff of physical injuries.
(5) Good Cause Procedure:
When a participant is notified that they failed to comply with ASPIRE-TANF rules and they claim, either orally or in writing, within five working days of receiving the notification, that they have Good Cause, the Department or the Department’s representative shall offer to meet with the participant.
a) The Department or the Department’s representative will schedule a meeting with the participant. A meeting will be scheduled by:
i. The Department or the Department’s representative contacting the participant by phone and agreeing on a location, date and time which is at least five days from the date of the phone contact; or
ii. A written scheduling notice mailed to the participant, when phone attempts for scheduling are unsuccessful. A written scheduling notice will be mailed to the participant a minimum of seven calendar days prior to the meeting date.
The meeting may be conducted by phone, as scheduled a minimum of five days in advance.
b) Meeting Requirements:
The Department or Department’s representative will:
i. Present a notice describing Good Cause and the participant’s rights to request Good Cause; and
ii. Verbally explain to the participant the reasons for which Good Cause may be granted and the participant’s right to apply for Good Cause verbally or in writing; and
iii. Provide an opportunity for the participant to request Good Cause either wholly or in part.
iv. Make a written record of the meeting including documenting that the participant was given the notice describing Good Cause, the opportunity to request Good Cause and the participant’s reason for requesting Good Cause.
c) Meeting Result:
i. The Department’s representative shall make a recommendation on the participant’s request for Good Cause, including the basis for the recommendation, in writing.
ii. The Department shall issue a final determination notice approving or denying, wholly or in part, the participant’s request for Good Cause. This notice will include the reasons for the Good Cause decision and the participant’s right to a fair hearing.
iii. The Department may deny Good Cause if the participant fails to attend the scheduled meeting under Subparagraph a above.
A. ASSETS
All assets owned whole or in part by the filing unit members must be evaluated for ownership, accessibility and value. All assets are counted unless specifically excluded by rule. The asset limit is $10,000.
Types of assets:
Liquid Assets: Liquid assets are those that are readily available such as cash, crypto-currency, bank accounts, Certificates of Deposit, lump sum paymentsstocks or bonds, individual retirement accounts, and annuities.
Nonliquid Assets: Nonliquid assets include vehicles, buildings, land, recreational property and the like. Money obtained through the conversion of a non-liquid asset to a liquid asset is considered an asset (such as sale of marital property).
Potential Assets: Potential assets are those that are obtainable but not readily available. The filing unit must show that steps are being taken to obtain any potential assets.
Ownership of an asset is determined by the name stated on the asset or a related document. If there is more than one name listed the asset is considered to be jointly-owned and the asset’s accessibility must be evaluated. Jointly owned assets are considered available in their entirety to each owner unless determined not accessible per (3) (a) below. For an asset which does not have a name stated on the asset or related document, ownership would default to who has possession of the asset.
An asset is not accessible if:
The property is jointly owned, cannot be subdivided and the joint-owner(s) will not agree to sell.
The portion of a joint bank account shown by convincing evidence to have been contributed by someone outside the filing unit and not meant to be a gift.
The asset is an irrevocable trust fund and no one residing in the home can revoke the trust or change the beneficiary. Trust funds are irrevocable when the family does not have the legal ability to convert them.
Portions of settlements that are earmarked and intended to be used for expenses not included in the TANF or PaS grant. See Subsection 5(d) and (n) below.
The value of an asset is the fair market value minus any encumbrances against it.
The equity value of a vehicle that is not excluded is determined using the National Automobile Dealers Association’s (NADA) Used Car Guide Book or the Kelley Blue Book, making appropriate deductions as listed in the guide including, but not limited to, options and special equipment.
A reduction can be made for a vehicle listed in the NADA Used Car Guide or the Kelley Blue Book, in less than average trade-in condition if true value is verified by a reliable source.
A household estimate can be made for vehicles not listed in the car guide unless it appears unreasonable as determined by the Department based on the current used vehicle market in Maine.
Excluded Assets:
One vehicle per licensed driver in the household;
Real property which the filing unit owns and occupies as their place of residence. The home and surrounding lot if not separated by property owned by someone else is exempt, even when left temporarily unoccupied because of employment, job training, education, illness or disaster. If the home is unoccupied, the filing unit must demonstrate the intent to return.
Real property which the household is making a good faith effort to sell, in a newspaper or through a real estate broker, at fair market value.
d) Income representing the change from a non-liquid to a liquid asset;
e) Prepaid burial contracts and burial spaces intended for use by the filing unit;
f) Household goods and personal effects used in the home;
g) Income Producing Property. Property, including real property, used in the production of income. This exclusion includes property not in use because of circumstances beyond the control of the individual, such as temporary disability, care of an ill person, disasters, etc. Likelihood of returning to the same employment must be evident;
h) Livestock used to produce income or intended for family consumption;
i) Any personal loan with an agreement to repay. The agreement must be verified by:
A written agreement signed by both parties to repay the money within a specified time; or
Evidence that the loan was obtained from an individual or establishment engaged in the business of making loans.
j) All educational grants, loans and scholarships from a recognized source to the extent the money is needed for educational expenses. Portions used to fill a need demonstrated to be directly related to successful completion of the Training or Education Program in excess of available funding from all other federal, state, public, private, and institutional sources of aid, excluding loans or federal work study, are also excluded;
The cash surrender value of insurance policies;
Family Development Accounts. Savings accounts for income eligible families to be used for specific purposes, to the extent that the total balance of the account remains below $10,000 per 22 M.R.S. §3762. Withdrawals may only be made for:
Expenses for education or job training to attend an accredited or approved post-secondary education or training institution;
The purchase or repair of a home that is the family’s principal residence;
The purchase or repair of a vehicle used for transportation to work or to attend an education or training program; or
Capital to start a small business for any family member 18 years of age or older.
m) A one-time cash compensation payment and accrued interest from the Baxter Compensation Authority to former students of the Baxter school for the Deaf, who were found to have been physically or sexually abused before January 2001.
n) Non-reoccurring payments, such as Build HOPE Project Grants, received by a participant when used within 30 days of receipt to meet one of the following needs:
i. Health care costs of a household member that are medically necessary and not covered by public or private insurance, or
ii. To address an emergency that may cause the loss of shelter, employment, educational progress or other basic necessities.
(6) Assets Excluded by Federal Statute:
a) Grants, loans and scholarships to graduates or undergraduate students made under any program administered by the U.S. Secretary of Education, such as Pell, SEOG, NDSL, Perkins, Work Study;
b) Federal Tax Refunds, including refundable credits, such as EITC, are excluded for 12 months from the month of receipt. P.L. 111-312;
c) Child Nutrition Act and National School Lunch Act - Value of supplemental food assistance;
d) Title VII, Nutrition Program for the Elderly-Older American Act benefits;
e) USDA Supplemental Nutrition (WIC) Program and/or Donated Commodities benefits;
f) Tax-exempt portions of payments made under the Alaskan Native Claims Settlement Act;
Payments made under Annual Contributions Contract under U.S. Housing Act;
Relocation assistance or allowance under the Housing Act: Also excluded are payments made under Title II of the Uniform Relocation and Real Property Acquisition Policy;
Agent Orange Settlement payments;
WIOA, Job Corps, or AmeriCorps payments of all types;
Payments resulting from Congressional action which specifically exclude such payment;
Maine Indian Land Claims Settlement payments;
Domestic Volunteer Services Act payments made to volunteers serving as foster grandparents, senior health aides or companions;
HUD community development block grant funds and escrow accounts in the Family Self Sufficiency Program;
o) Home Energy Assistance Program (HEAP) benefits or any other federal program providing energy assistance;
p) Title I payments to volunteers such as VISTA: Payments that exceed the minimum wage are not excluded;
q) Radiation Exposure Compensation Act settlements for injuries or death from nuclear testing or uranium mining;
r) Assets owned solely by an excluded stepparent;
s) Property of no saleable value;
t) Nazi Persecution Victims Eligibility Benefits - Payments made to victims of Nazi persecution excluded from consideration per P.L. 103-286.
B. INCOME
Consider the income of all members of the filing unit including excluded stepparents, sponsors of noncitizens, specified relatives, and all persons who are required to be members of the child’s assistance group except insofar as they are excluded from the assistance group for a reason such as lack of U.S. citizenship or the imposition of a sanction or disqualification.
Types of Income.
Earned Income: Money earned in exchange for labor or services and received in cash or in-kind for wages, tips, commissions, crypto-currency or net profit from activities in which the individual is engaged as self-employment. The gross income before deductions for taxes, personal or employment expenses, or garnishments. This includes:
Seasonal Income: Money earned in exchange for labor or services not required year around such as fishing, clamming, worm digging, logging, harvesting and the like;
Contract Income: Money earned in exchange for labor or services in a period shorter than one year and not paid on an hourly or piecework basis to workers, such as school teachers or bus drivers.
Wages that are garnished or diverted by an employer (see exceptions in (d) below).
Unearned Income: Unearned income is money (including crypto-currency) that is not produced by labor or services. It includes benefits such as Social Security, Veterans benefits, pensions, unemployment compensation, Worker’s Compensation, dependent allotments, contributions, support payments, annuities, dividends, interest, and regular
withdrawals from trust funds. Unearned income may be garnished or diverted (see exception in (d), below).
Deemed Income: A portion of the income of certain individuals who have a legal obligation to members of the assistance group must be considered through the deeming process. The deemed amount is counted as unearned income to the assistance group. (See Ch. IV(C) for treatment of deemed income.) Examples of individuals whose income may be deemed:
Individuals such as parents who, although required to be included in the assistance group, are ineligible due to non-financial criteria and therefore are not members of the assistance group;
Excluded stepparents;
Sponsors of noncitizens and their spouses.
Garnished Income: Garnishment to earned or unearned income is not considered income in the following instances:
Income is garnished to fulfill the terms of court ordered support/alimony or Title IV-D support orders; or
Income is garnished/recouped by the same agency that issued the income, such as unemployment benefits being recouped to satisfy a prior overpayment.
Potential Income: Money which could be received if action were taken to obtain it, such as from Social Security, Unemployment or VA benefits or by asserting a legal claim such as inheritance.
Excluded Income.
Child Support
Collections which are retained by the Department; and
The first $50 per month received by the filing unit.
ASPIRE support services payments;
HOPE support service payments as defined in 10-144 Chapter 330;
General Assistance, Emergency Assistance, HUD, FMHA utility reimbursements and other supplemental assistance from public or private agencies to help the assistance unit meet their basic needs;
Income of children not in the assistance unit;
Wages of dependent children in the assistance unit if they are full-time students or part-time students not employed full time;
Income-In-Kind, Vendor Payments, Outside Contributions: These are payments or contributions toward budgeted items from organizations or people not in the assistance group paid directly to a third party;
When an involuntary separation occurs where the client or spouse enters a medical institution, the income of the institutionalized spouse will be considered for that person only. This treatment of income applies in the following situations:
The spouse is placed in an Intensive Care Facility or Specialized Nursing Facility;
The spouse is hospitalized in a general hospital for more than 60 days; or
The spouse is hospitalized for a kidney transplant.
Any personal loan from any source providing there is clear evidence of an agreement to repay. The following is acceptable evidence:
A written agreement signed by both parties to repay the money within a specified time; or
Evidence that the loan was obtained from an individual or establishment engaged in the business of making loans.
Reimbursements for job related expenses to the extent they do not exceed actual expenses;
Gifts of money not to exceed $150 per household in a three-month period ending with the month of receipt;
Portions of all educational grants, scholarships, and other awards from a recognized source to either graduates or undergraduates not already totally excluded by Federal statute (Subsection 3(a) below) with the exception of:
The portion of any assistance given to students which is not used on actual educational costs; and
Any dependent portion of VA educational assistance.
Monies received as a match on deposits a recipient makes in their Family Development Account or Separate Identifiable Account set up as authorized by statute at 22 M.R.S. §3762 up to the $10,000 cap. Accrued interest on these accounts is also excluded as income;
A one-time cash compensation payment and accrued interest from the Baxter Compensation Authority to former students of the Governor Baxter School for the Deaf, who were found to have been physically or sexually abused before January 2001;
o) Non-reoccurring lump sum payments in the month they are received. Including but not limited to Build HOPE Project Grants, personal injury awards, lottery winnings and inheritances’
p) Compensation and reimbursements for participation in committees, councils, and advisory boards that are related to health and human services programs. These groups may be established by the legislature, state agencies, or local non-profit organizations. Compensation and reimbursement includes stipends, legislative per diem, travel reimbursement, and other similar payments;
q) Means tested, training and education related stipends intended to help the assistance unit meet their basic needs.
Income Excluded by Federal Statute.
Grants, loans and scholarships to graduates or undergraduate students made under any program administered by the U.S. Secretary of Education, such as Pell, SEOG, NDSL, Perkins, Work Study;
Federal Tax Refunds, including refundable credits, such as EITC, are excluded for 12 months from the month of receipt. P.L. 111-312;
Child Nutrition Act and National School Lunch Act - Value of supplemental food assistance;
Title VII, Nutrition Program for the Elderly-Older American Act benefits;
USDA Supplemental Nutrition (WIC) Program and/or Donated Commodities benefits;
Tax-exempt portions of payments made under the Alaskan Native Claims Settlement Act;
Payments made under Annual Contributions Contract under U.S. Housing Act;
Relocation assistance or allowance under the Housing Act: Also included are payments made under Title II of the Uniform Relocation and Real Property Acquisition Policy;
Agent Orange Settlement payments;
WIOA, Job Corps, or AmeriCorps payments of all types;
Payments resulting from Congressional action which specifically exclude such payment;
Maine Indian Land Claims Settlement payments;
Domestic Volunteer services Act payments made to volunteers serving as foster grandparents, senior health aides or companions;
HUD community development block grant funds and escrow accounts in the Family Self Sufficiency Program;
Home Energy Assistance Program (HEAP) benefits or any other federal program providing energy assistance;
Title I payments to volunteers such as VISTA: Payments that exceed the minimum wage are not excluded;
Radiation Exposure Compensation Act settlements for injuries or death from nuclear testing or uranium mining;
r) Nazi Persecution Victims Eligibility Benefits - Payments made to victims of Nazi persecution under P.L. 103-286.
PROSPECTIVE BUDGETING: Eligibility and benefit levels are calculated for all assistance groups using prospective budgeting. Prospective budgeting is a method by which benefit levels are calculated using a best estimate of income, disregards, deductions and other circumstances of individuals who are the members of the assistance group and individuals whose income must be deemed to the assistance unit. For purposes of determining the amount of the TANF payment and the amount of income to be counted, the payment month and budget month are the same. The following definitions are used in this chapter:
Prospective eligibility means that eligibility for any given month is determined by estimating, as accurately as possible, whether all eligibility factors will be met during that entire month.
Income is available when it is received or can be reasonably anticipated. Reasonably anticipated means that the amount of income can be estimated, and the date of receipt is known.
Best Estimate: The best estimate is based on the Department’s reasonable expectation and knowledge of current, past, or future verified circumstances. In making this determination the concepts of significant and non-significant income changes and averaging must be used.
Significant Income Changes: Changes in sources or amounts of income which are expected to continue long enough to be reflected in at least one check, such as starting or losing a job or a new source of unearned income, or changes in hours and wages.
Non-Significant Income Changes: Changes that are temporary, short term and not part of the ongoing pattern, such as fluctuations due to irregular overtime or unpaid days off and other changes not expected to continue beyond the month of occurrence. Variations in income caused by non-significant changes are not considered underpayments or overpayments.
INCOME DISREGARDS: Income disregards are certain income amounts subtracted from the filing unit’s countable gross income to determine the total countable income amount. For self-employment the income is annualized, and the applicable disregards are deducted from the monthly average.
Disregards will not be applied to, and any Step disregard month forfeited by, any individual for any month in which the individual, without good cause, terminates their employment or reduces their earned income within the 30 days preceding that month; refuses to accept employment when offered within 30 days preceding that month; fails to report an increase in earned income within 10 days from the date of income receipt; or are sanctioned for noncompliance of any TANF/PaS requirement.
Work Related Disregards. These disregards are applied to applicants to determine initial eligibility and to program recipients in the assistance group who are employed.
Earned Income Disregard. Each individual in the filing unit who is employed, including self-employed, is eligible for the following disregards from earned income:
One hundred eight dollars; and
Fifty percent of the remaining earnings.
Child or Dependent Care. After applying all the other disregards, the cost of care for each dependent child or incapacitated adult needing care while the TANF recipient works. Deduct the actual cost up to $175 per month per dependent or $200 for children under the age of 2. Dependent care is not allowed as a deduction if paid to anyone living in the home.
Step Disregard: The following disregard is applied to the individual’s earned income when determining benefit levels for the assistance group when the individual included in the assistance group meets the following criteria. They are:
A current recipient with new employment that was obtained while actively participating in, and in compliance with, the TANF/PaS and ASPIRE programs; or
A current recipient with an increase in earned income; and
The increase in earned income occurred while actively participating in, and in compliance with, the TANF/PaS and ASPIRE programs.
The Step disregard is applied to each applicable recipient with earnings as defined above. The two-steps included in the Step disregards are each restricted to a three-month maximum. When Step one is activated the Step disregard will continue for the maximum six months consecutively unless the recipient reports that all earned income for that recipient has ended, or they meet the conditions included in (d) below. When earned income has ended the Step month count will end the month following the month the Step disregard is used to determine benefits. The Step disregard is applied as follows:
Step one: 100% of earned income for the individual is disregarded for a maximum of three months for either an applicant with earned income or for a recipient with a change of earned income.
Step two: 75% of earned income for the individual is disregarded for a maximum of three months following exhaustion of Step one months during a period of TANF and/or PaS eligibility.
In the event that the Step disregard does not increase the TANF/PaS benefit beyond the benefit amount determined by the use of the Work Related ((2) above) and Other disregards((4) below); then the Step disregard is not applied, and the Step disregard usage month is not counted for the individual.
For any period in which a household’s food supplement assistance is reduced below $50 as a result of the use of the Step disregard; the household will be issued a TANF Earnings Food Benefit of up to $50. This benefit is issued as a food assistance benefit, not a cash benefit, and may be used only as permitted by Maine’s Supplemental Nutrition Assistance Program (SNAP) (10-144 C.M.R. Ch. 301). The combined food assistance benefit is not to exceed $50 in a benefit month.
The Step disregard is not used to determine TANF countable income for the purpose of determining eligibility for a Special Need Housing Allowance or Gap child support payments.
The Step disregard is not used when determining eligibility or benefits levels for Emergency Assistance, Alternative Aid, Transitional Child Care or Transitional Transportation.
Other Disregards. The following disregards may be applied to individuals with earned or unearned income. When the recipient has both earned and unearned income, the applicable disregards are allowed once.
Dependent Allocation. If an adult member of the assistance group is legally responsible for the support of others living in the home who are not included in the of TANF or PaS assistance group and who do not have assets more than the allowable limit, allocate the appropriate full need standard from the adult’s remaining income. This does not include the needs of individuals required to be in the filing unit but who have been sanctioned. The dependent allocation applies to both earned and unearned income.
Child Support/Alimony Deduction. If an adult member of the assistance unit is legally responsible for and actually paying alimony to a former spouse or child support, the support payment is allowed as a deduction. This deduction is only allowed if the payee is living outside the home.
DEEMED INCOME: The income of certain individuals who live with and are related to the minor child, must also be considered through the deeming process. The deemed amount is counted as unearned income to the assistance unit.
Individuals whose income is deemed:
Excluded Stepparent: When the stepparent has chosen to be excluded from the assistance group, the disregards and allocations in (B) above, will be applied to their gross monthly income. The remainder of the excluded stepparent’s income is budgeted as unearned income to the assistance group. Assets solely owned by the excluded stepparent are not considered available to the filing unit even if the legal parent is included on the grant.
Lump Sum Income of Excluded Stepparent: The lump sum income of the excluded stepparent is considered an asset and not as income in the month received.
Sanctioned specified relatives: Specified relatives of a child in the filing unit living in the home and are disqualified from receiving TANF benefits. When the specified relative has been sanctioned and removed from the assistance group, they are not eligible for any disregards. Income and assets of the sanctioned specified relative are counted in full.
Sponsors of noncitizens and their Spouses: These are people who have signed an affidavit of support as an noncitizen's condition of entry into the United States. Sponsors may or may not live with the unit. See (D) (5), below.
TREATMENT OF SPECIAL INCOME:
Income of specified relatives and their spouses who are not parents of the dependent child. When specified relatives are excluded but claim the children as dependents for income tax purposes, they have acknowledged that they meet at least half of the child’s needs. The benefit level will be determined using half of the appropriate full need standard for the child as countable unearned income.
Self-Employment Income: Self-employment income is income earned by individuals engaged in their own business enterprises. Self-employment income is averaged over a 12-month period. This applies even when the income is received in a shorter period. If the 12-month average is not an accurate reflection of circumstances or if a business has been in operation less than a year, income will be averaged for the months in operation or treated like any other fluctuating income based on verification provided. Seasonal self-employment which supplements other income shall be averaged over the season.
Verification: Self-employment is verified in the following method:
Income tax returns; provided the business has been operating long enough to have filed and the prospective year is anticipated to be similar to the year reflected in the taxes.
Business records may be provided for those that have been operating less than one year or when it is claimed that circumstances are different than during the previous tax year.
b) Determination of Income.
i. Use all gross self-employment income including the full amount of capital gains and depreciation claimed on the tax return.
ii. Subtract the cost of producing the income.
a. The following expenses may not be subtracted:
1. Payments on the principal of the purchase price of income producing real estate, capital assets, equipment, machinery or other durable goods. Interest on these payments is allowed.
2. Net losses from prior periods.
3. Federal, state and local income taxes, retirement plans, and work-related personal expenses such as transportation to and from work.
4. Depreciation.
b. The following expenses must be subtracted:
1. Cost of labor including, FICA, State and Federal taxes.
2. Cost of materials.
3. Rent.
4. Interest.
iii. Divide the net earnings by the number of months over which the income is to be averaged.
iv. Apply disregards and treat the net self-employment income as any other earned income.
Income from Boarders and Roomers: The cost of producing income by providing “board and room” will be the actual cost of providing meals and a room per month per individual. “Room” only is the actual cost of providing a room per month. “Board” only is the actual cost of providing meals per month.
Non-Recurring Lump Sum Income: Non-recurring lump sum income may be in the form of retroactive payments such as Social Security, Workers’ Compensation, Unemployment, VA or other benefits, settlements, inheritance, lottery winnings, pay raises, divorce settlements and the like. Non-recurring lump sum income shall be considered an asset in the month received, and not as income.
(4) Income representing the change from a non-liquid to a liquid asset, such as the sale of marital property is considered an asset, not a lump sum.
(5) Income of Sponsors of Noncitizens: A sponsored noncitizen is a person lawfully admitted for permanent residence to the U.S. for whom a person (the sponsor) has executed an affidavit of support (USCIS Form I-864, Affidavit of Support under Section 213A of the Act”) on behalf of the noncitizen. The date of entry or admission is the date established by the USCIS as the date the noncitizen was admitted for permanent residence.
a) Deeming income of the sponsor: Sponsor deeming is a process used to determine the eligibility for and amount of TANF benefits that a sponsored noncitizen may receive. These deeming rules only apply to sponsored noncitizens who have executed the legally binding, I-864 Affidavit. The deeming period continues until the sponsored noncitizen becomes a U.S. citizen, has earned, or can be credited with, 40 qualifying quarters of coverage as defined in Title II of the Social Security Act (42 U.S.C. 401 et seq.), departs the U.S. permanently, or dies.
i. Noncitizens Required to File an I-864 Affidavit: Most family-based noncitizens, including immediate relatives, family preference noncitizens, and some orphans, must submit an affidavit of support on USCIS Form I-864 if they file adjustment of status or noncitizen visa applications on or after 12/19/97. In addition, an employment-based immigrant who is coming to work for a relative or for a company where a relative of the immigrant owns 5% or more of the company must file an I-864 Affidavit. These are noncitizens who have lawful permanent resident (LPR) status. Immigration through a family member or through employment are two paths to lawful permanent residency. The I-864 becomes enforceable at the time the noncitizen becomes an LPR. Noncitizens in these categories who have earned, or can be credited with, 40 qualifying quarters of coverage as defined in Title II of the Social Security Act, are not required to submit an I-864 Affidavit.
ii. The sponsor and the sponsor’s spouse’s income are counted in its entirety and is available to the sponsored noncitizen in determining the sponsored noncitizen’s eligibility for benefits. No deductions are given. If a sponsor is liable for more than one noncitizen, the deemed income and assets shall be divided equally among the sponsored noncitizen.
iii. Exceptions to sponsor deeming: Sponsor deeming would not apply for a 12-month period if:
The sponsored LPR or certain family members have been determined to be victims of domestic violence or extreme cruelty. The 12-month period can be extended if the abuse or cruelty is recognized by a court order, an Administrative Law Judge, or the INS, AND the victim does not live with the batterer.
The sponsored LPR would be indigent (unable to obtain food and shelter without government assistance). If determined indigent, then only the amount of income and assets provided by the sponsor or the sponsor’s spouse would be deemed to the LPR. Each indigent determination is renewable for additional 12-month periods.
(6) Attributed Tips: The recipient is responsible for maintaining a daily log of actual tips, which will be used to verify countable tip income for budgeting purposes. Tips attributed or allocated to employees by their employers on paystubs or W-2 forms are not considered actual tips and shall not be used in computing TANF and PaS payments.
(7) Child Support Paid by the Non-Custodial Parent: Payments from a non-custodial parent are considered child support and are the income of the child for whom the support is paid. When TANF is granted the household must surrender all court ordered or voluntary child support payments to the department.
Child Support collected by the department: Child support is considered unearned income for the dependent child. Child support paid for an adult child over age 18 who no longer lives in the home is countable unearned income to the adult receiving the payment.
Pass Through Payments: Up to the first $50 per month per assistance unit of child support collected on the monthly support obligation for the assistance unit will be paid to the assistance unit. This payment is excluded as income and an asset in determining need and the amount of the payment. The pass-through payment amount will not be considered as part of any overpayment when support is received directly by the recipient and is not forwarded to the State.
TANF Supplemental Payments (Gap): When there is a deficit (gap) between the maximum TANF payment and the Standard of Need, the assistance unit may be eligible to receive a gap payment. Gap payments are made from the prior month’s total child support collections, less the pass-through, if any. The maximum gap payment is the amount of the unmet need less countable income.
Excess Payments: When child support collected exceeds the debt owed by the non-custodial parent the excess amount may be paid to the family if there is no outstanding overpayment debt.
When current child support is collected and occasionally exceeds the total of the pass through, gap, and the benefit amount, the recipient is sent the excess and eligibility for TANF continues.
When it can be anticipated that the child support collected will routinely exceed the total of the pass through, gap, and benefit amount, eligibility for TANF ends.
E. INCOME CALCULATION:
(1) All income received in the four weeks immediately preceding the application or review must be verified.
Exception: When income stops, the Department will verify the termination and verify only the income received in the month of application and thereafter. This may be less than four weeks of income.
(2) Determine if there were any significant income changes or anticipated significant income changes.
a) Continuous changes will be used in determining the on-going estimate.
b) Anticipated significant income changes will be used only if they must be acted on now.
(3) Income Averaging: Convert the income not received or paid monthly to a monthly amount using the following methods:
a) Multiply weekly amounts by 4.3;
b) Multiply biweekly amounts by 2.15;
c) Multiply semimonthly amounts by 2; or
d) Average amounts received for a period of more than one month.
e) When less than a full month’s income is anticipated, the actual monthly income will be used.
(4) Determine Gross Income: Gross income is income available during the budget month and is calculated before the application of any disregards and includes:
a) The total of earned and unearned income, of those individuals in the assistance group; and
b) The portion of any income deemed to the assistance group (see C, above).
(5) Apply Disregards in the following order:
a) For the initial income determination:
i. Earned Income Disregard
ii. Dependent Allocation
iii. Child Support/Alimony Deduction
iv. Child or Dependent Care
b) For the second income determination:
i. Step Disregard
ii. Dependent Allocation
iii. Child support/Alimony deductions
iv. Child or Dependent Care
INCOME ELIGIBILITY TESTS:
(1) This test is used for determining eligibility for applications.
a) When the assistance group’s initial income determination, E (5)(a) above, exceeds the Standard of Need there is no eligibility for TANF/PaS.
b) When the assistance group’s initial income determination, E (5)(a) above, is less than or equal to the Standard of Need, proceed to the calculation of the payment.
(2) This test is used for determining ongoing eligibility.
When the assistance group’s initial income determination, E (5)(a) above, and applicable second income determination, E (5)(b) above, both exceed the Standard of Need there is no eligibility for TANF/PaS.
When the assistance group’s initial income determination, E (5)(a) above, or applicable second income determination, E (5)(b) above, is less than or equal to the Standard of Need, proceed to the calculation of the payment.
CALCULATION OF PAYMENT:
(1) Calculate the Basic TANF Grant: Subtract the initial income determination, E (5)(a) above, from the Standard of Need (SON) using the appropriate chart in the Appendix. The benefit is the difference between the two figures up to the payment maximum (see appendix).
(2) If eligible for a Step Disregard, B (3)(c, e and f) above, Calculate the alternative Basic TANF Grant: Subtract the second income determination, E (5)(b) above, from the Standard of Need (SON) using the appropriate chart in the Appendix. The benefit is the difference between the two figures up to the payment maximum (see appendix).
(3) Use the correct Basic TANF Grant amount from 1 or 2 above per the stipulations for the application of the Step Disregard, B (3)(c, e and f) above.
(4) Special Need Housing Allowance (SNHA):
TANF assistance groups that incur housing costs that equal or exceed 50% of their countable income may be eligible for a SNHA payment of up to $300 per month. A separate application for SNHA is not required. The TANF or PaS application or redetermination is considered a request for SNHA. A person can receive an SNHA even if not receiving a TANF basic grant. Assignment of child support and ASPIRE participation is required in this circumstance. Child only assistance units may be eligible for the SNHA.
b) Countable Housing Expenses: The total expenses that the TANF or PaS assistance unit is responsible for even when they have been unable to pay that amount. These expenses must be verified.
i. Rent, lot rent, mortgage payment, property taxes and homeowner’s insurance.
ii. Any housing costs paid by General Assistance are considered the responsibility of the assistance unit.
iii. Subsidized housing situations: The portion of rent used in the SNHA calculation is the portion allocated to the individual and does not include the portion paid by the housing entity.
iv. Shared housing costs: When the TANF recipient resides in a home with others who are not included in the filing unit (see Chapter II) the responsibility for housing costs is determined by who is responsible for the tenancy at will agreement, lease, or mortgage.
Count all of the housing costs if the individual responsible for the housing costs is in the filing unit. Any contributions to housing costs by individuals outside of the filing unit will be treated as unearned income to the individual;
Count a prorated share of the housing costs if:
1. The individual responsible for the housing costs is a caretaker relative receiving a child only payment; or
2. The individual responsible for the housing costs is a parent or child excluded from the assistance unit because of receipt of SSI or State Supplement.
Count none of the housing costs if the individual responsible for the housing costs, is not in the filing unit. Any voluntary contributions to housing costs made by the TANF individual to the holder of the rental/mortgage agreement are not considered countable for the SNHA.
c) Payment Determination
i. Determine eligibility for the basic TANF or PaS grant as in (G) (1) above.
ii. When the assistance unit is eligible for TANF or PaS, administer the 50% Test:
a. Add the basic TANF or PaS grant amount plus child support (minus $50 pass-through), plus countable income.
b. Determine total shelter costs
c. Divide total shelter costs (b) by the total of the basic grant plus child support plus countable income (a).
d. When the amount obtained in (c) is equal to or greater than 50% subtract the TANF or PaS countable income from the Special Need Full Standard of Need. The grant amount is the deficit up to the maximum Special Need payment for the size of the assistance group.
(5) If the result is less than $1 before application of any recoupment or proration, no benefit is issued.
(6) Round the benefit down to the next whole dollar.
(7) The TANF assistance group will receive the highest level of TANF benefits they are eligible to receive as defined in Section G.
TOTAL BENEFITS PACKAGE: A TANF recipient with child care needs has the option of:
(1) Receiving their TANF payment plus the child care assistance, up to the maximum market rate as determined by OCFS, as a “total” benefit” or
(2) Receiving their TANF payment and having the child care assistance paid directly to the child care provider. Unless specified by the recipient, the child care payment would be paid to the child care provider.
TRANSITIONAL CHILD CARE (TCC)
Transitional Child Care (TCC) provides child care benefits to eligible families who received TANF/PaS in any one of the three months immediately preceding the month of ineligibility.
TCC benefits are only available during the time the specified relative works and only for—
Children under the age of 13 needing care while their specified relative works at paid employment.
Children aged 13 through 19 who are physically or developmentally incapable of caring for themselves. The physical or developmental impairment must be verified by a physician, certified nurse practitioner, or licensed psychologist;
Children receiving SSI or IV-E Foster Care;
Children who enter the household, and for whom the former TANF/PaS specified relative has legal responsibility, during the transitional period and otherwise meet all requirements.
b) In a two-parent household at least one parent must be working at paid employment in order to receive TCC benefits. If only one parent is employed, the other parent must be, either—
i. Enrolled in an education or training program as verified by a copy of the parent’s class schedule or
ii. Unable to care for the children due to having a disabling condition as verified by medical evidence.
Eligibility Criteria: The family must meet the following criteria:
TANF/PaS Closure: The TANF/PaS case must have closed because—
There was an increase in earned income, except in the following situations:
The case closed because of increased earnings of the excluded stepparent required to deem income to the assistance group (Ch. IV, C, Deemed Income); or
The specified relative with earned income was excluded from the TANF/PaS assistance group;
There was an increase in child support;
The family voluntarily closed the case; and/or
The family reached the 60-month lifetime limit.
Income:
At TANF/PaS closure one or both parents must be working at paid employment; and
The family’s gross weekly income must be equal to or less than 250% of the Federal Poverty Level (FPL) for their family size. The income of all members of the filing unit is counted.
Non-Financial Requirements:
The family must reside in Maine.
The child(ren) must be a U.S. Citizen or noncitizen potentially eligible for federally funded assistance as defined in Chapter II.
Eligibility Process:
The Department shall open TCC, beginning the month following receipt of the last TANF/PaS benefit, for families who were receiving child care services through ASPIRE-TANF at the time of TANF/PaS closure and who meet the eligibility requirements for TCC , without additional request.
Families who were not receiving child care services through ASPIRE-TANF at the time of TANF/PaS closure may request TCC verbally or in writing. This request must be made within 12 months of TANF/PaS closure. TCC begins on the day of request if eligible. There is no retroactive TCC payment.
A child care disregard used in the calculation of the TANF/PaS benefit (Chapter IV § B(2)(b)) ends the month following the month of TANF/PaS receipt.
Parent Fee Requirement:The parent fee will be waived for any family with a gross weekly income equal to or less than 250% FPL.
TCC Benefit Calculation:
TCC benefits are calculated prospectively for a seven-day period beginning on Sunday.
TCC benefits are based on the market rate cap and are derived from the 75th percentile rate charged in the county where child care is provided. The Office of Child and Family Services determines the Market Rate (see Appendix, page 4).
TCC benefits are calculated in the following manner:
Calculate the gross weekly income: If the gross income is greater than 250% of the FPL, there is no TCC eligibility. When the gross income is less than or equal to 250% of the FPL, proceed to (ii), below;
Calculate the Parent Fee:The parent fee will be waived for any family with gross weekly income equal to or less than 250% FPL.
Calculate each child’s TCC payment.
For each child, identify the Market Rate Cap based on the following:
1. Child’s age group:
Infant: birth through 12 months
Toddler: 13 months through 36 months
Preschool: 37 months through 60 months
School Age: 61 months (or younger if attending kindergarten) through 19 years
Type of child care facility:
Licensed child care center
Licensed family child care
Legal Unregulated child care
County where the child care is located
Number of hours of child care needed: The Department may only authorize child care for the number of hours the parent works each week. The number of work hours is used to determine the applicable Market Rate Cap percentage for payment as defined below:
Child Age Group | Full-time Fee 100% of Cap hour requirement | Three-quarter time Fee 75% of Cap hour requirement | Half-time Fee 50% of Cap hour requirement | One-quarter time Fee 25% of Cap hour requirement Infant Toddler Preschool | 30+ hours per week | 20-29 hours per week | 10-19 hours per week | Less than 10 hours per week School Age | 30+ hours per week | 11-29 hours per week | 6-10 hours per week | Less than 6 hours per week
Night-Time Employment: Parents who are employed at night may be approved for a maximum of eight additional hours of child care for sleep time. Children shall not remain in care longer than 18 hours within a 24-hour period.
Parents who are required to travel to the child care provider may be approved for additional hours to accommodate for the time spent driving to the child care provider on the most direct route to and from work.
b. Compare the provider’s cost to the Market Rate Cap. The Department pays the actual cost charged by the provider or the Market Rate Cap, whichever is less. This figure is considered the cost of care.
Special Needs Child Care: The Department may pay child care rates in excess of the market rate cap for children requiring specialized care due to a physical or mental impairment. Verification of the impairment and the need for specialized care is required.
c. Subtract the parent fee from the cost of care the Department will pay, the difference is the TCC benefit.
TCC Payment Issuance: The Department shall divert the TCC benefit to the child care provider unless the recipient requests otherwise.
Reporting Responsibilities: TCC payments remain constant until a redetermination is completed, or until the recipient or child care provider reports a change that affects the amount of TCC benefits.
a) TCC recipients are required to report the following changes within ten days of occurrence:
i. Employment ceases,
ii. The second parent in the home no longer is a student, has a disability, or is employed,
iii. A child leaves the home,
iv. It becomes known to the family that the child will not receive services from the provider for a period of two or more days,
v. A change in child care providers takes place,
vi. A change occurs to the number of child care hours needed due to changes in employment or travel time, or
vii. A change in income causing the gross income to exceed 250% of the Federal Poverty Level.
Otherwise, recipients must report income changes at least annually through the eligibility redetermination process.
b) TCC providers are required to report the following changes within ten days of occurrence:
i. It becomes known to the provider that the child will not receive services from the provider for a period of two or more days,
ii. A change in child care providers takes place, or
iii. A change occurs to the number of child care hours provided.
Redetermination: All TCC cases must have a benefit eligibility redetermination at least once every 12 months as defined in Chapter I(F). The redetermination date aligns with a Medicaid and/or Food Supplement redetermination whenever possible. An interview is not required to determine ongoing TCC eligibility.
Termination of Benefits: TCC benefits terminate, without 10 days’ notice, when—
A redetermination is not completed;
Employment ceases;
The TCC family fails to provide requested verification;
There are no eligible children in the home;
The TCC family is determined to be income ineligible; or
Nonpayment of Parent Fee: See Subparagraph 4(c)(ii) above. Upon notification by the child care provider and confirmation by the Department that the parent failed to pay the parent fee, the Department shall end the TCC. If the parent has made a good faith effort to make payment, or has entered into a payment plan with the provider and evidence has been provided that the parent is in compliance with that plan, the Department may continue TCC.
Application for TANF/PaS: If a TCC recipient’s hours are reduced and the recipient then reapplies for TANF/PaS, the recipient may continue to receive TCC until ASPIRE makes a determination about the suitability of child care supports. There must not be a duplication of receipt of child care benefits.
Break in Assistance: When TANF/PaS has been closed for more than 12 months and there has been a break in receipt of TCC of 90 days or less due to the following reasons, the family remains eligible for TCC.
The family member loses a job for good cause as defined in 10-144 C.M.R. Ch. 607, ASPIRE-TANF Program Rules, Section 4(III)(C) but secures another job prior to reopening of a TANF/PaS grant;
There is a break in employment due to seasonal or planned layoff;
Maternity leave; or
Medical leave.
Child Care Providers:
Providers must be 18 years of age or older.
The provider cannot be a parent, stepparent or guardian of the child or reside in the same household as the TCC recipient;
Unlicensed providers and all adult members of their household must undergo a background check every two years. The background check must be completed before any funds are released to that provider.
The Department reserves the right to disapprove a provider chosen by the parent with cause, as determined by the TANF Program Manager.
Overpayments: Overpayments occur when the amount paid exceeds the amount that would have been paid if the benefit had been calculated correctly on actual circumstances reported, verified and acted on in a timely manner. Overpayments can occur as the result of agency, specified relative, or child care provider error. A party in wrongful receipt of a TCC benefit shall be responsible for repaying the overpayment. TCC benefits issued to the specified relative and not used to pay a child care provider are considered an overpayment which must be repaid by the specified relative. A child care provider that receives payment and either fails to render services or fails to satisfy the Reporting Requirements articulated in Section 6 of this chapter shall be liable for reimbursement and any related costs, including interest.
Recovery of Overpayments:
a) Errors caused by the Department or the specified relative: The Department may recover the value of any outstanding TCC overpayment. Such actions can include, but are not limited to
i. offsetting future TANF/PaS benefits,
ii. seeking recoupment from a child care provider, or
iii. referring the matter to the Department’s Fraud, Investigation and Recovery Unit for collection.
Overpayments caused by the child care provider: The Department may recover the value of any outstanding TCC overpayment regardless of any other debt the specified relative may owe to the provider. The Department may, to the extent allowed by law, take whatever action is deemed appropriate to recover such overpayment.
TRANSITIONAL TRANSPORTATION (TT)
Transitional Transportation (TT) provides benefits to eligible families, to include:
Families who received TANF/PaS in any one of the three months immediately preceding the month of TANF/PaS ineligibility, are working at paid employment, and are financially eligible may qualify for TT.
i. TT is available for up to 18 months when requested within twelve months of TANF/PaS closure.
ii. The Department shall notify individuals of the possibility of transportation reimbursement and of the necessity to submit an application if interested at the time of TANF/PaS closure.
iii. These Families must meet the criteria detailed in Subsection 2(a) below.
b) Other families working at paid employment may qualify for TT:
i. They include those who—
a. have not received TANF/PaS in the last three months, or
b. had TANF close in the last three months but do not meet the criteria defined in Subsection 2(a).
ii. The following conditions apply to these families:
a. TT is available for up to 18 months within a 36 month period starting from the month of TT application, dependent on funding availability. Months accrued in this section and section a) above are cumulative.
b. The Department may provide, at its discretion, up to $1,400,000 annually for each state fiscal year (SFY) from Maine’s Temporary Assistance for Needy Families block grant for families eligible under this paragraph.
1. When the Department determines that the funding limit will be reached or exceeded, the Department may close all current cases eligible under the provisions of this paragraph providing timely and adequate notice as described in Chapter I(I).
2. When the current SFY funding limit has been reached or the Department determines that the funding limit will be reached or exceeded in the current or next assistance month it may deny all applications eligible under the provisions of this paragraph that would be subject to this limit. The Department shall issue a written notice of decision in accordance with the application process described in Subsection 3 below.
3. A new, $1,400,000 period begins each state fiscal year which begins July 1 and ends June 30.
(a) If Households apply in June and would be denied based on the funding limit, the Department shall simultaneously determine eligibility for June and July.
(b) Households who applied prior to June 1 and were denied or closed, must reapply for a determination to be made for July.
c. The eligibility criteria detailed in Subsection 2(b) below apply.
Eligibility Criteria: The family must meet one of the following criteria:
TANF/PaS Closure Families: the specified relative must meet the following criteria:
i. The TANF/PaS case must have closed because—
a. There was an increase in earned income except in the following situations:
1. The case closed because of increased earnings of an excluded stepparent required to deem income to the assistance group (Ch. IV, C, Deemed Income);
2. The specified relative was excluded from the TANF/PaS assistance group; or
3. The adult member(s) of the TANF/PaS assistance group are no longer eligible for TANF/PaS due to not being a U.S. Citizen or noncitizen potentially eligible for federally funded assistance as defined in Chapter II;
b. The TANF/PaS recipient has earned income but has requested their benefits be terminated; or
c. The TANF/PaS case has reached or exceeded the 60 month lifetime limit and the TANF/PaS recipient is employed during the month of TANF/PaS closure.
and
ii. The family must have gross monthly income equal to or less than 250 percent of the Federal Poverty Level for their family size. The income of all members of the filing unit is counted.
Non-TANF/PaS Closure Families: The specified relative must meet the following criteria:
They must have a dependent child(ren) under age 18 in the household;
They must be working at paid employment;
They must incur an employment related transportation expense;
They must be a U.S. citizen or noncitizen potentially eligible for federally funded assistance as defined in Chapter II; and
v. The family must have gross monthly income equal to or less than 200 percent of the Federal Poverty Level for their family size.
Application Process:
Eligibility for TT is determined upon receipt of a written request for TT on a form required by the Department. The request must include the applicant’s name, address, and signature. The application date is the date the paper or electronic document is received by the Department.
Missing documentation and verification must be requested by the Department in writing. Applicants have at least 10 days from the date of the letter to provide requested information to the Department. Failure to provide requested verifications within this timeframe results in denial of the application.
The Department shall issue a written decision within 30 days of receiving a completed application. If the decision is to deny the application, the notice of decision must state the reason(s) for the denial and notify the individual of their right to appeal the decision.
Appeals of Department denials must be filed within 30 days of the date of the Department’s written decision. All other rules regarding the Administrative Procedures outlined in Chapter VI apply.
Payment Calculation:
Payment is calculated by determining how many miles the participant travels to and from work each day multiplied by the anticipated number of working days in the month.
NOTE: Mileage is for the most direct route to and from the recipient’s home and their place of employment. Mileage includes necessary trips to a child care provider and to the home of car pool passengers.
Effective January 1, 2025 mileage is reimbursed consistent with the State of Maine mileage reimbursement rate set by the Department of Administrative and Financial Services Office of the State Controller found at https://www.maine.gov/osc/travel/mileage-other-info.
TT mileage reimbursement shall not exceed $20 per day.
Payment: Payment is made monthly, on the first day of the month. Payment is for travel costs incurred in the month of payment. TT is paid as long as a transportation expense is incurred, no matter the method of transportation.
Reporting Responsibilities: TT payments remain constant until a redetermination is completed, or until the recipient reports a change that affects the amount of TT benefit.
Within ten days of its occurrence, TT recipients must report all changes that affect eligibility, including—
Employment ceases,
A change in the distance driven to work or to child care provider,
A change in the number of working days per month,
A household member leaves the home, and
An increase in gross income beyond the applicable income limit.
Redetermination: All TT cases must have benefit eligibility redetermined following the first twelve months of receipt. In some situations, the Department may shorten the redetermination period to coordinate with an anticipated change that would affect eligibility.
Benefits automatically terminate when—
a scheduled redetermination is not completed,
employment ceases,
the last eligible child leaves the home, or
the TT family is determined to be income ineligible.
Overpayments: Overpayments occur when the amount paid exceeds the amount that would have been paid if the benefit had been calculated correctly on actual circumstances reported, verified, and acted on in a timely manner. Overpayments can occur as the result of errors on the part of the agency or a specified relative. The specified relative shall be responsible for repaying the overpayment.
Recovery of Overpayments: The Department may recover the value of any outstanding TT overpayment by offsetting future TANF/PaS benefits, or by referring the matter to the Department’s Fraud, Investigation and Recovery Unit for collection.
FAIR HEARINGS/ADMINISTRATIVE HEARINGS
A TANF or PaS assistance group has an opportunity for a fair hearing when it disagrees with actions affecting their benefits. Any request for a hearing must be made within 30 days of the date of action. The Department may waive time limits. Requests for hearings may be made orally or in writing at the Regional Office or at the Central Office. All decisions of fair hearing officers are binding on the Department with the exception of cases involving an Order of in which case the Commissioner reserves the right to make the final decision.
NOTE: Recipients who are dissatisfied with any action will upon request be given the opportunity to discuss their case with the immediate supervisor. The assistance group will be advised that this meeting with the supervisor is optional and will not delay or replace the fair hearing. The basis for this meeting will be a review of the case situation to determine any available resolution of the problem.
Time Limits on Hearings
The 30 day time limit on requesting a hearing may be extended at the discretion of the Department for one of the following reasons:
1. the recipient has registered a prior complaint on the same action
2. the recipient was unable to request earlier due to circumstances beyond their control
The decision to extend the request deadline is made by the Administrative Hearings Unit. A fair hearing need not be granted when either State or Federal law requires automatic grant adjustments for classes of recipients (mass changes) unless the reason for the request is incorrect budget computation.
FAIR HEARINGS
The Department has 60 days from the date of the initial request to hold the hearing, render the decision and notify the household. Decisions will be implemented promptly.
NOTE: When an Order of is requested the time period is extended to 90 days (See Administrative Hearings Manual, Chapter VI, Section B, page 5).
NOTE: There may also be an extension of this 60 day time limit in the instance when a continuance is requested.
Departmental Responsibilities on Hearing Requests
1. Provide documents and records requested by the recipients or their representatives,
2. Advise the recipient that they may present their own case or may have the aid of others including legal counsel,
3. Advise the recipient of legal services available.
4. Provide the recipient with adequate opportunity to:
a. examine the contents of the case file and all documents and records to be used by the Department at the hearing at a reasonable time before the date of the hearing as well as during the hearing;
b. present witnesses in their own behalf;
c. subpoena witnesses;
d. establish pertinent facts;
e. advance any arguments without undue interference; and
f. confront and cross-examine adverse witnesses.
Denial/Dismissal
The Administrative Hearings Unit cannot deny or dismiss a recipient's or applicant's hearing request unless:
1. the request is not received within 30 days of the action;
2. the request is withdrawn by the recipient or their representative in writing;
3. the recipient or their representative fails to appear at the scheduled hearing, and does not present evidence that their absence was beyond their control; or
4. the request is where the sole issue is one of State or Federal law requiring automatic grant adjustments for classes of recipients.
Continuation of Benefits
When a TANF or PaS household requests a hearing within 10 days of the date of the termination or reduction notice, benefits will be restored to the immediate prior amount unless the household waives restoration of benefits.
The continuation of benefits may be terminated if the hearings officer decides the sole issue is one of policy or if other changes occur which effect the grant following the request for a hearing.
When the hearing request is not made within 10 days, benefits must be reduced or terminated, as stated in the notice.
Notification of Hearing
The time, date and place of the hearing must be arranged taking the convenience of the household into consideration. Written notice must be provided at least 10 days prior to the hearing. The notice shall:
1. give the time, date and place of the hearing;
2. give the address and telephone number of the Administrative Hearings Unit;
3. explain that the request shall be dismissed if the household or its representative fails to appear without good cause;
4. include the hearing procedures;
5. include the purpose of the hearing;
6. include the rights to present evidence, cross-examine opposing witnesses, be represented by legal counsel, to subpoena witnesses, and to have the hearing rescheduled or continued for good cause; and
7. include the rights to judicial review under Maine Rule 80C if dissatisfied with the results of the hearing.
Consolidation of Hearings
TANF and PaS Administrative Disqualification Hearings may be combined with a fair hearing or a Food Supplement Program Disqualification Hearing, when the factual issues arise out of the same or related circumstances, and the recipient receives prior notice that the hearings will be combined. If hearings are combined, the time frames for conducting Administrative Disqualification Hearings will be followed unless the household waives the 30 day notice requirement for a disqualification hearing (explained under Intentional Program Violation).
The Hearings Officer
Hearings are conducted by a Department hearing officer. The hearing officer:
1. administers oaths to all witnesses;
2. ensures that all relevant issues are considered;
3. requests, receives, and makes part of the record, all necessary evidence;
4. regulates the hearing consistent with due process;
5. records proceedings for filing; and
6. renders a decision based on evidence or testimony presented.
Attendance at the Hearing
The hearing must be attended by a representative from Eligibility Staff as well as a representative from the agency responsible for the action under appeal, if different. Participation could involve representation from ASPIRE-TANF or DSER. There must also be at least one TANF or PaS household representative or the request for a hearing will be considered abandoned by the assistance group.
Household's Rights
1. The TANF or PaS household will be given an opportunity, upon request, to examine all evidence at a reasonable time before the hearing, as well as at the hearing. The contents of the case file will be made available.
EXCEPTION: The following will not be disclosed:
a. names of persons who have provided information about on the household and want to remain anonymous;
b. information pertaining to pending criminal prosecution;
c. information that is protected from release, such as IEVS information.
2. They may present the case itself or have it presented by legal counsel or other person.
3. They may bring witnesses.
4. They may advance arguments without undue interference.
5. They may submit evidence to establish all relevant facts and circumstances in the case. (When the hearing involves medical issues, a medical assessment other than that of the person involved in the original decision may be requested by the household at the expense of the agency.)
6. They may subpoena witnesses.
The Hearing Decision
The decisions of the Hearings Unit must comply with Federal and State law and regulations, and be based on the hearing record. This record must be available, upon request, to the TANF or PaS household or its representative at any reasonable time for copying and inspection at no cost to the client.
Decisions of hearings officers are binding on the Department with the exception of cases involving an Order of Reference where the Commissioner reserves the right to make the final decision.
Within 5 days of the decision by the hearing officer, a copy of the decision, its basis, and the TANF or PaS household's rights to judicial review under Maine Rule 80C, will be mailed to the client.
In situations where the benefits have been continued at the previous level and the decision is that the Department was correct in its action, an overpayment will be established for the additional benefits received from the date of the change to the date of the adjustment after the hearing.
In situations where the benefits have not been continued at the previous level and the decision is that the Department was not correct in its action, a corrective payment shall be made for the period specified in the hearing decision.
TYPES AND METHOD OF PAYMENTS
GENERAL RULE: The TANF, PaS and RCA benefits will be issued using one or more of the following methods:
1. Direct Deposit (DD) System;
2. Electronic Benefit Transfer (EBT) System; or
3. Check.
Beginning April 1, 2003, Cumberland and York County applicants and recipients will have their benefits delivered by an electronically coded debit card known as The Pine State Card, unless the applicant or recipient elects to have their TANF, PaS or RCA benefits electronically deposited directly into a personal bank account. The rest of the state will participate in the EBT system beginning June 1, 2003 or shortly thereafter.
When an applicant or recipient asks the Department to send a portion of a benefit to a vendor, such as a landlord, on the applicant’s or recipient’s behalf, the vendor payment will be sent by check.
A creditor cannot attach any portion of the TANF, PaS or RCA payment, regardless of the method of delivery.
A regular payment is unrestricted and gives the recipient the right to be responsible for and free to select, purchase and pay for goods and services, except as otherwise prohibited herein.
A restricted payment gives the agency permission to direct payment to a third party. Restricted payments are limited to:
1. Vendor Payment: a TANF or PaS payment made directly to a landlord, a utility, or another vendor of goods and services. Requests for vendor payments must be made in writing by the recipient. The agency will confirm in writing to the recipient when and where payment(s) will be sent. A request for change must come from the recipient.
EXCEPTION: While most vendor payments are voluntary payments which are requested by the recipient, minor parent or pregnant minor must receive TANF or PaS benefits in the form of vendor payments unless they are married minors living with spouses. In these cases, the minor parent or pregnant minor will receive direct TANF or PaS payments.
TYPES AND METHOD OF PAYMENTS
These mandatory monthly vendor payments will pay for rent and utility payments first.
When a request for a vendor payment or a change in vendor payment is received by the 10th day of the month, it is effective the next month. Requests received after the 10th day of the month are effective not later than the month following the next month's payment.
A vendor payment will not be authorized when the requested payment is more than the grant amount. When a vendor payment is less than the grant amount the balance will be sent to the recipient unless the recipient is a minor parent described at item 2.b.
NOTE: When either the vendor payment or the payment to the third Party payee is less than $5, they must be adjusted to comply with State law requiring a $5 minimum for all checks issued.
2. Protective payment: a TANF or PaS payment made to a guardian, conservator, or other third party on behalf of a recipient (third party payee). The third party payee is responsible for the accounting of the disbursement of funds to the agency. A protective vendor payment shall be made when:
a. there is non-compliance with ASPIRE-TANF or DSER. The agency have final approval in the selection of a third party payee. (See ASPIRE-TANF policy at Chapter II, and DSER policy at Chapter II .)
b. a minor parent or pregnant minor is head of the TANF or PaS household. No TANF or PaS benefit will be sent directly to the minor parent or pregnant minor. All TANF or PaS benefits will be sent in the form of a voucher/vendor payment in the following instances:
shelter payments are sent directly to vendors.
utility payments (preferably a standard payment plan) are sent directly to vendors.
balances remaining are sent to third party protective payees who must manage and use the money on behalf of the minor parent and their children.
In situation b, the agency will have final approval in the selection of a third party payee. The payee must be a responsible adult who can make responsible financial decisions. Additionally, the payee must agree to demonstrate to the agency (at any time) how the protective payments have been spent on behalf of the minor parent and their children.
c. there is a court appointed guardian or conservator. The Eligibility Worker is responsible for referring to the Bureau of Child and Family Services reports of persistent mismanagement of the TANF or PaS payment which threatens the health and safety of a child. Children not properly fed, clothed, sheltered or other lack of care is evidence of mismanagement. This referral process may lead to court action resulting in the appointment of a guardian or conservator.
Prior to the effective date of the intended change, the recipient must be notified in writing.
Procedure for Payment to a Vendor/Protective Payee.
The third party payee name, address and amount will be entered into the computer.
The check will be paid to the order of the third party payee on behalf of the client. The stub must reflect this information.
SUBJECT: Types of Information Required and Source Agencies
GENERAL RULE: Federal regulations require that each state maintain and use an Income and Eligibility Verification System (IEVS). Wage and benefit information is requested from the following sources:
1. Wage information maintained by the Maine Employment Security Commission (MESC);
2. Information about net earnings from self-employment, wages, and payments of retirement income maintained by the Social Security Administration (SSA) - "BEERS”;
3. Federal retirements and survivors, disability, SSI and related benefit information available from SSA - "BENDEX" AND "SDX";
4. Unearned income information from the Internal Revenue Service (IRS); and
5. UIB claim information from MESC.
Information will be requested from the appropriate agencies about members of the household as follows:
1. Quarterly, from MESC on wages. Such requests must include all assistance groups which participated in any month of the corresponding quarter.
2. Monthly, from SSA data bases and not later than the second month of the eligibility period.
3. Annually, from IRS for all current recipients. This request must be made as soon as practicable after the latest year's data is available from IRS.
4. Weekly, from MESC on UIB benefits for all participating assistance groups.
Verification: Action must be taken without independent verification based on Social Security and SSI benefit information from SSA and UIB information from the Maine Employment Security Commission obtained through IEVS. This information is considered verified upon receipt.
NOTE: When it appears that the IEVS information about a particular household is questionable, the information must be considered unverified and must be independently verified before taking action to terminate, deny, or reduce benefits. Such unverified information is:
unearned income from IRS;
wage information from the Maine Department of Labor and SSA (BEERS);
questionable information as noted above.
Verification shall be obtained by means of contacting the household and/or the appropriate asset or income source.
The household must be informed in writing of the information the Department has received.
Worker Responsibilities
GENERAL RULE: Case action on IEVS information about recipient households must be complete within 45 days of receipt of that information.
Case action includes:
1. Review of the information, and comparison of it to information in the case record.
2. For all new or previously unverified information received, contact with the household and/or the appropriate assets or income source to resolve discrepancies.
3. When discrepancies warrant, action to begin reduction of benefits or termination of eligibility (advance notice sent).
Appropriate case action and dates must be noted on the IEVS document and filed in the case record with the exception of documents containing IRS information. All documents generated from IRS source data must be destroyed once case action is completed. A master file of IRS documents will be maintained at Quality Control. BEERS data contains IRS information and is subject to the same security.
OVERPAYMENTS
GENERAL RULE: Whenever federal, state, or support money is issued incorrectly as a result of an agency or client error, an overpayment shall be calculated for each month federal, state or support money was misdirected. The amount of the overpayment is the difference between what was received and what should have been received.
Misdirected federal, state, and support money includes, but is not limited to, benefits issued as:
Temporary Assistance to Needy Families (TANF)
Parents as Scholars (PaS)
Refugee Cash Assistance (RCA)
Alternative Aid Assistance (AAA)
Emergency Assistance (EA)
Transitional Child Care (TCC)
TANF of PaS Child Care Disregard
TANF or PaS Child Care Support Services
Transitional Transportation (TT)
Pass Through (Pass Thru)
TANF Supplemental Payment (GAP)
Excess Child Support (also, alimony, childcare)
ASPIRE Support Services
Other money issued
Whenever there is a TANF or PaS recalculation, the Eligibility worker shall consider the possibility of a TANF Supplement GAP overpayment.
NOTE: A TANF or PaS overpayment due to a recipient keeping child support shall be calculated minus the Pass Thru.
NOTE: When it appears that an overpayment resulted from a willful client error, the Eligibility Worker must proceed with steps described in Intentional Program Violation.
When overpayments are due to incorrect Pass Thru, Excess Child Support or Alimony payments (Excess over), or other misdirected payments (payment to the wrong person), the Eligibility Specialist will be notified by DSER/Staff.
When overpayments are due to incorrect ASPIRE, Support Services, or other misdirected payments, the Eligibility Specialist will be notified of the overpayment amount by ASPIRE Staff.
Overpayments to sponsored aliens: Aliens and their sponsors are jointly and separately liable for any overpayment made to the alien during the three years after the alien's entry into the U.S. due to the sponsor's failure to provide correct information, except when the sponsor is without fault or good cause exists or the sponsor signed a new affidavit under PRWORA. When a sponsor signs an affidavit under
PRWORA, the duration of joint and separate liability exists until an alien becomes a citizen or the alien earns 40 quarters of coverage under the Social Security System.
It is the Eligibility Specialist’s responsibility to correct errors relating to all misdirected federal, state, or support monies. The Eligibility Specialist must attempt to recover overpaid money from the recipient by sending notice which explains the cause of the overpayment a choice on how the overpayment can be repaid, and the right to a hearing.
NOTE: All types of overpayments are subject to adequate noticing which includes fair hearing rights.
NOTE: Repayment shall take place through direct payment or benefit reduction and will be recovered from:
- any assistance group which was overpaid,
- any assistance group of which a member of the overpaid assistance group has subsequently become a member, or
- any individual members of the overpaid assistance group whether or not currently a recipient. See exceptions for minors below.
Priority for Recovering Overpayments
1. The agency is required to first seek recovery from the caretaker relative who was a member of an overpaid assistance group (or the caretaker relative’s current assistance group).
2. If the caretaker relative and all other adults of an overpaid assistance group cannot be located, are deceased, were not a member of the overpaid assistance group, or have had the overpayment discharged in bankruptcy, the agency must seek recovery from other members of the overpaid assistance group. See exceptions to minors below.
The Federal Government requires the collection of AFDC (Aid to Families with Dependent Children) overpayments before TANF overpayments.
AFDC overpayments occurring prior to 10/01/96: An AFDC overpayment must be collected from any individual, including a minor, who was in the household at the time the overpayment accrued. However, the Department will only collect AFDC overpayments from former AFDC minor dependents when the former AFDC minor receives federally funded public assistance as an adult.
All other overpayments: Overpayments, other than AFDC overpayments occurring prior to 10/01/96, must not be collected from individuals who were a minor dependent in the household at the time the overpayment accrued.
Recovery
Overpayments, regardless of their cause, must take place over as short a period of time as possible without recovering more than the maximum recovery amount. The maximum recoupment of overpayments from a recipient eligible for maximum TANF or PaS payment is 10% of the payment standard, and for those eligible for less than the maximum TANF or PaS, 30% of the payment standard.
Recoupment of overpayments will be made by direct repayment or through a reduction in the amount of
NOTE: Households can pay faster than the 10% or 30% rate by written request.
NOTE: An Eligibility Worker's decision to recover overpayments at a rate of less than the maximum amount must be explained clearly in the case record.
NOTE: When the recoupment of an overpayment reduces an TANF or PaS payment to under $5, the amount of the recoupment must be adjusted to comply with State law which requires a $5 minimum on checks issued.
If an applicant with an outstanding overpayment becomes eligible, recoupment must take place considering the current payment amount.
Recovery on Closed Cases
When a case is closed and there is an outstanding overpayment, there must be an automatic referral to Fraud, Investigation and Recovery (FIR) staff who will contact the former recipient regarding an agreement to repay. FIR may also attach State Income Tax returns to offset the remaining debt.
INTENTIONAL PROGRAM VIOLATION
GENERAL RULE: A determination of an intentional program violation (IPV) is made either through a court of law or a hearing process. The hearing process is known as an Administrative Disqualification Hearing (ADH). Sanctions are imposed on recipients found to have committed an IPV.
Definition
An IPV is an action by a recipient for the purpose of establishing or maintaining the family's eligibility for TANF, PaS or any other Bureau program or service such as, Emergency Assistance, Alternative Aid Assistance, Transitional Childcare, Transitional Transportation, ASPIRE support services and any other misdirected money, for increasing or preventing a reduction in the amount of the grant, which stem from the following intentional act:
1. false or misleading statements or misrepresentations, concealment, or withholding of fact. For example when a recipient intentionally states no income on an application review or change report form when there is income in his household.
OR
2. an act intended to mislead, misrepresent, conceal, withhold facts or propound a falsity. For example, when a recipient gets a baby-sitter to lie about the amount of child care expense. Another example is when a recipient signs a forgery affidavit requesting that an TANF OR PAS check be replaced when they signed and cashed the original.
Pre-hearing Review and Initiating an ADH
The Department must review the evidence at hand to determine if an allegation that a recipient has committed an IPV is valid. When the Eligibility Specialist believes that documentary evidence substantiates the allegation, the Eligibility Specialist should:
1. initiate an Administrative Disqualifications Hearing, and
2. correct the on-going benefits when they are wrong.
NOTE: Continued eligibility and benefit level must be determined as for any other household pending the hearing.
NOTE: A fair hearing request resulting from the benefit adjustment can be combined with the ADH. See Consolidation of Hearings.
NOTE: Collection activities on overpayments do not begin until a determination has been made as to whether or not an IPV has occurred. See Absence of IPV and Finding of IPV.
Non-Referrals
When the following situations occur, do not refer suspected IPV to an ADH:
1. a prior alleged IPV referral is at the Attorney General's office,
2. a case has been through the court system and was dismissed or determined not guilty, or
3. the alleged IPV occurred prior to 10/4/93 and did not continue thereafter.
NOTE: Alleged Intentional Program Violations occurring on 10/4/93 and thereafter can be referred to an ADH even when the alleged IPV began prior to that date.
Time Limits
The Department has 90 days from the date the hearing notice is received to hold the hearing, render the decision, and notify the household. However, failure to comply with this time limit will not bar a finding that the person committed an IPV.
Scheduling of the ADH
Written notice to the person accused of the violation must be mailed at least 45 days in advance of the scheduled hearing in order to assure that the notice is received 30 days prior to the hearing. The notice, a copy of the hearings procedures, and the opportunity to waive the right to a hearing is mailed "CERTIFIED/RETURN RECEIPT REQUESTED/RESTRICTED DELIVERY."
The notice must contain:
1. The date, time, and place of hearing.
2. The charges against the recipient believed to have committed the IPV.
3. A summary of the evidence, and how and where it can be examined.
4. A warning that if the accused recipient fails to appear for the hearing without good cause, the decision will be based on the evidence provided by the Eligibility Worker at the hearing.
5. A statement that the accused recipient may request a postponement of the hearing provided that the request is made to the Administration Hearings Unit at least 10 days prior to the date of the scheduled hearing.
If the recipient fails to appear and later requests that the hearing be rescheduled, they must present good cause for failure to appear within 10 days of the date of the hearing.
6. A warning that if the hearing decision determines that an intentional program violation has occurred, a disqualification period will be imposed according to the appropriate schedule on page 30 of this chapter.
7. A statement that the State may still prosecute the household member in civil or criminal court action and collect the over issuances.
8. A listing of individuals or organizations that provide free legal representation to recipients alleged to have committed an IPV.
9. A statement that the accused recipient has the right to remain silent concerning the charges and that anything said or signed by the recipient concerning the charges may be used in a court of law.
10. An explanation that the accused recipient may waive their right to appear at an ADH. (See Waiver)
Returned Notice
When the notice is returned marked "undelivered" or accepted by someone other than the addressee, personal service shall be arranged by any other method which provides proof of receipt at least 30 days to the hearing.
This means that the local DHHS office must request that the ADH be rescheduled allowing another 45 days.
NOTE: A personal service restricts delivery of the notice to the addressee and guarantees proof of receipts. Examples include:
1. Certified Mail with "Return Receipt Requested and Restricted Delivery."
2. Delivery by a Sheriff's Department with "Return Receipt Requested and Restricted Delivery."
3. Delivery by a Detective Agency with "Return Receipt Requested and Restricted Delivery."
When the notice is returned marked "refused," it must be assumed that the addressee received notice.
Failure to Appear
Should the accused recipient fail to appear at the hearing, and the notice was received or refused at least 30 days prior to the hearing date, the hearing will still be conducted. The hearing officer will base the decision on the evidence presented by the Department.
When a recipient fails to appear at the scheduled hearing, but notifies the Administrative Hearing Office of the reason for not attending not more than 10 days after the hearing date, they may claim good cause for the failure to appear.
Good cause for failure to appear is defined as an emergency circumstance that is beyond the control of the recipient and that prevents the recipient from being able to appear at the hearing.
NOTE: The following situations do not constitute good cause:
1. Forgetting about the hearing
2. Lack of transportation, unless the lack of transportation was the result of an emergency situation such as the recipient's vehicle breaking down on the way to the hearing.
Postponement of Hearing
A recipient may request a postponement of the scheduled hearing if the request is made to the Administrative Hearing Office at least 10 days in advance of the scheduled hearing.
Only the Hearing Officer is authorized to postpone a hearing. When the hearing is postponed, the time limits for processing will be extended for the number of days between the initial scheduling and rescheduling not to exceed 120 days.
Withdrawal of the Request for an ADH by the Department
When, at any time prior to the date of an Administrative Disqualification Hearing, the Department feels that there is insufficient evidence on which to conduct a hearing, the Administrative Hearings Officer and the recipient should be contacted immediately to notify them that the hearing has been canceled and that the case had been administratively withdrawn.
Consolidation of Hearings
Bureau Program or Service Administrative Disqualification Hearings may be combined with a fair hearing or a Food Supplement Program Disqualification Hearing, when the factual issues arise out of the same or related circumstances, and the recipient receives prior notice that the hearings will be combined. If hearings are combined, the time frames for conducting Administrative Disqualification Hearings will be followed unless the household waives the 30 day notice requirement for a disqualification hearing.
Waivers
When a waiver of the right to an Administrative Disqualification Hearing (ADH) is signed by the recipient, the appropriate disqualification penalty is imposed, even when there is no admission to the charges.
The waiver notice contains the following information:
1. The date by which the signed waiver must be received by the local office of the Department.
NOTE: This date is the date of the hearing. This allows recipients to waive their right to an ADH at the hearing.
2. A blank for the signature of the accused recipient and the head of household along with a statement that the head of household must also sign if the accused is not the head of household.
3. A statement that the recipient has the right to remain silent concerning the charges and that anything said or signed by the recipient concerning the charges may be used in a court of law.
4. The fact that the signed waiver will result in disqualification for the appropriate period of time even if the recipient does not admit to the charges.
5. An opportunity for the person either to admit the charges or to waive the hearing without admitting to the charges.
The Administrative Disqualification Hearing
The Eligibility Worker (or Supervisor when the Eligibility Worker is absent) is responsible for representing the agency at the hearing.
The recipient accused of IPV or a person they designate in writing to represent them may review the case record and/or represent them at the hearing. The statement designating the representative must be kept in the case record and a copy must be forwarded to the Administrative Hearing Office. The designated representative will receive a copy of all correspondence regarding the hearing proceedings.
During the hearing, the recipient has the right to:
1. examine the contents of the case record which includes all documents and records to be used by DHHS at the hearing;
2. bring witnesses to present testimony on their behalf during the hearing;
3. present their case or have it presented by legal counsel or other person;
4. advance arguments without undue interference;
5. question or refute any testimony or evidence including the opportunity to confront and cross examine adverse witnesses; and
6. submit evidence to establish all pertinent facts and evidence in the case.
Conducting of the Hearing
The Hearing Officer will conduct the hearing in accord with the pertinent statutes and regulations. The Hearing Officer will:
administer the oath to all witnesses who will present testimony;
2. request, receive, and make part of the record all evidence determined necessary to decide the issues being raised;
3. insure that an unrepresented recipient feels at ease and assist in presenting facts relevant to his/her defense;
4. advise the accused recipient of his/her right to refuse to answer questions during the hearing; and
5. regulate the conduct and course of the hearing consistent with due process to insure an orderly hearing.
Standard of Evidence
The Department will present evidence that the recipient:
1. made a false or misleading statement or misrepresentation, concealed facts, or withheld facts, or acted with the intent to mislead, misrepresent, conceal, or withhold facts or propound a falsity;
2. did it intentionally; and
3. did it in order to receive Program or Service benefits to which they were not entitled.
Decision
The Hearing Officer shall, based upon clear and convincing evidence in the hearing record, issue a written decision stating whether or not the accused recipient knowingly committed an IPV, specify the reasons for the decision, and identify the supporting evidence and regulations as defined earlier in this chapter.
Notice of ADH Decision
The Administrative Hearings Officer will issue a decision within 90 days of the date of the notice scheduling the ADH unless the hearing has been rescheduled and the time frames extended. The Administrative Hearings Officer will send a copy to the local DHHS office.
Absence of IPV
When the AHO determines the facts do not support an IPV or a court determines the client is not guilty, the Eligibility Worker:
1. enters the overpayment on the computer; and
2. follows procedures for collection as a client unintentional error (or agency error).
Finding of IPV
When the AHO determines that an IPV occurred, the Eligibility Worker:
1. refers the case to the Fraud Investigation and Recovery (FIRU) for collection of the overpayment and for potential prosecution by entering the overpayment on the computer as an intentional error.
NOTE: When the AG's office considers a case for prosecution, Eligibility staff will be asked to recompute the overpayment allowing work related disregards because the courts do not recognize the sanctions. The Department will recover both the court-ordered overpayment and the additional overpayment which results when sanctions are applied.
2. provides the client with written notification of the Disqualification sanctions before they are imposed, and the disqualification notice will note the date the Disqualification period begins and ends;
3. imposes the sanctions; and
4. establishes the overpayment.
Disqualifying Sanctions/Penalties
The following periods of Disqualification will be imposed against the recipient who committed the violation:
If the offense occurred before 9/1/97:
1. Six months for the first violation.
2. Twelve months for the second violation.
3. Permanently for the third violation.
If the offense occurred on or after 9/1/97:
1. One year for the first violation
2. Two years for the second violation
3. Permanently for the third violation
NOTE: Sanctions will always begin no later than the second month following the date the household member is sent written notification of the hearing decision or a waiver to forfeit an administrative hearing is signed. The disqualification period for recipients determined to have committed a program or service intentional program violation will not be postponed when households are ineligible for benefits.
Actions taken as the result of an IPV require adequate and timely notices. The sanctioned recipient's needs will not be included in the standard of need when determining eligibility and amount of assistance for the remaining family members. The sanctioned recipient's income and assets will be considered. The following disregards will be applied to the income:
1. an amount equal to the standard of need for the support of any non-categorically eligible individuals living in the same household and claimed by the sanctioned parent as dependents for IRS purposes;
2. any actual payments of alimony or child support to persons not living in the home;
3. any actual payments being paid by the sanctioned parent to individuals not living in the home, but who are claimed or could be claimed as dependents for IRS purposes.
Duration of Penalty
No further administrative appeal procedure exists after an Administrative Disqualification Hearing decision finds an IPV. The determination of IPV made by an ADH Officer cannot be reversed by a fair hearing decision.
The recipient, however, is entitled to seek relief on the findings of IPV in a court having appropriate jurisdiction, but in no event shall the duration or the period for which such penalty is imposed be subject to review by the Hearing Officer.
Applicability of Penalty
A disqualification penalty imposed on a recipient by one IV-A State agency may be used in determining the appropriate Disqualification penalty for the recipient by another IV-A State agency. When a recipient with a prior violation moves from one state to another and has been found to have committed an Intentional Program Violation, the Department will impose the penalty based on the number of such violations committed in other states.
In cases where a Disqualification penalty and other sanctions or penalties apply:
1. The Disqualification penalties in this section must be imposed subsequently to, and cannot be substituted for, any other sanctions or penalties which may be imposed by law for the same offenses; and
2. The Disqualification penalties imposed under IPV only affect the recipient concerned. Other members of the Assistance Group cannot be substituted.
Collection of the Overpayment
There is no distinction between collections of intentional overpayments or unintentional overpayments. Refer to the Overpayments section for procedures.
UNDERPAYMENTS
GENERAL RULE: Underpayments are benefit or service payments issued for less than the amount the assistance group should have received.
The Department shall take action within 30 days from when the underpayment becomes known to correct the payments to current or former clients. The corrective payment shall not be counted as income or asset in the month it is received nor in the month following its receipt.
Corrective payments are a means of rectifying an agency error, delay or as a result of court order. They are not made when the client fails to notify the agency of changes.
Corrective payments shall be made for the entire period of error.
NOTE: If an assistance group has both an underpayment and an overpayment one shall be offset against the other before issuing a corrective payment.
Lost, Stolen, Destroyed or Forged Checks
GENERAL RULE: When a recipient reports a check has been lost, stolen or destroyed prior to cashing, the Department has the responsibility to replace it with reasonable promptness. In the instances when there is reason to believe there has either been a forgery or duplicate checks have been received and cashed by the recipient, the following procedures have been established.
Lost, Stolen or Destroyed
1. The worker checks the returned check list on or after the 12th of the month. If the check has been returned to the Division of Financial Services then the address is corrected by the Eligibility Worker on the computer and the Worker requests is made for remailing.
2. If the name is not on the returned check list, the Worker does the following:
a. Completes a SWIM-050 (Stop-Payment). The original is sent to the Division of Financial Services. The copy is for the record.
b. Completes a SWIM-051 (Application for a Duplicate Check). The original is sent to the Division of Financial Services. The copy is for the record.
NOTE: Both the SWIM-050 and the 051 are sent to the Division of Financial Services together.
Forgeries
When the photocopy of the original check is sent to the worker, the Worker has to meet face-to-face with the recipient to determine whether or not the signature is the recipient’s. If the recipient states it is not, then 2 separate original Forgery Affidavits will be completed (SWIM-052),one original is sent to FIR and the second original is sent to Division of Financial Services. A copy is retained for the record. This initiates an investigation to determine who cashed the check.
If the recipient agrees that the signature on the original check is theirs, the worker will initiate collection activities or refer for fraud.
Exchanging a Check
When a household presents a mutilated check which a bank refuses to cash, the worker will take the following steps:
1. Complete a SWIM-050 (Stop Payment);
2. Complete a SWIM-051 (Application for a Duplicate Check);
3. Void the mutilated check; and
4. Forward the original forms and the mutilated check to the Division of Financial Services. A copy is retained for the record.
Agency Error/Emergency Situation
When TANF or PaS grants are reinstated after check selection because of termination caused by an agency error or when a fair hearing is requested timely but after check selection, the following procedure shall be required:
1. Upon request from the recipient the replacement check will be authorized within 3 to 5 working days from the determination that there is an emergency situation. Emergency is defined as follows:
a. The TANF or PaS check for the month will likely not be received until after the 5th business day of the month; and
b. As a result of the delay the TANF or PaS family may lose basic necessities. For example, the family may:
be evicted from their home (e.g., there is an eviction notice and the grace period in which to pay the rent will expire; or
2. be in default on a loan because of expiration of the period in which to make a payment on the household's automobile or other installment loan used to purchase a basic necessity; or
3. be faced with the expiration period in which to pay for a necessary utility and as a result the service will be shut off; or
4. suffer because of the inability to purchase a basic necessity.
Basic necessity is defined as shelter (housing and/or utilities), food, clothing, or essential medical care. In these situations, the recipient must be without their own resources to meet the need and there must be no other source of assistance available which is adequate to meet the emergency. These other sources do not include the Emergency Assistance Program or Energy Crisis Intervention Program because they are limited. The recipient shall be required to apply for General Assistance unless receipt of that assistance will require a household member to perform workfare.
When the Worker determines that an "emergency" exists, a request to issue an expedited replacement check will be made through the TANF and PaS Supervisor. The Worker may request verification from the recipient or others that the "emergency" exists. The check will usually be available within 3 to 5 business days after the TANF and PaS Program Director approves the request for expedited payment.
ELECTRONIC BENEFITS TRANSFER (EBT) SYSTEM
TANF, PaS and RCA applicants and recipients will receive benefits by an electronic coded debit card known as the Pine Tree Card. The card will be used to access benefits from a point of sales (POS) device at retail stores or an automatic teller machine (ATM).
Under some circumstances benefits may be issued by direct deposit or vendor payment. See pages 8-11 of this Chapter;
Each Assistance Group case head will be issued an EBT card and a Personal Identification Number (PIN); and
Each Assistance Group will be allowed a maximum of two (2) payees/cardholders to access cash benefits.
Fees
Purchases and cash withdrawals made through a POS device will not incur fees.
Withdrawals or balance inquiries made at an ATM will get two (2) free transactions. All subsequent transactions will cost 65¢, in addition to the bank’s ATM surcharge and will be subtracted from the cash benefits at the time of the transaction. If the total of the transaction amount is not available in the recipient’s EBT account at the time of the transaction, the transaction will be rejected.
Lost or stolen cards - Recipients must report lost, stolen or damaged cards to the EBT Customer Service Help Desk.
Dormant Benefits – Benefits become dormant when they have not been accessed for 90 days.
When benefits have not been accessed for 60 consecutive days the recipient is notified that if benefits are not used within 30 additional consecutive days, they will become dormant on the 91st day.
Benefits can become available between the 91st through 180th day if the recipient contacts the department to request activation.
Benefits are expunged on the 181st day.
Purchases
Cardholders can make purchases from participating retailers and if funds are available, the balance on the card is reduced by the exact amount of the purchase.
Restrictions on the use of the EBT system
A recipient may not expend benefits using their EBT card or money obtained through the EBT system for the purchase of the items listed below (all references are to the Maine Revised Statutes, Title 22, unless another title is indicated):
Tobacco products, as defined in section 1551, subsection 3;
Imitation liquor or liquor, as defined in Title 28-A, section 2, subsections 13 and 16, respectively;
Gambling activity, as defined in Title 8, section 1001, subsection 15;
Lotteries conducted by the State pursuant to Title 8, chapter 14-A or the Tri-State Lotto Commission pursuant to Title 8, chapter 16;
Bail, as defined by Title 15, section 1003, subsection 1;
Firearms, as defined by Title 12, chapter 901, section 10001;
Ammunition, defined as a cartridge case, primer, bullet, or propellant powder designed for use in any Firearm;
Vacation or travel services, defined as any transportation service (vehicle, air, train, bus, boat) that is incurred for an extended period of recreation or holiday, or any other costs incurred for such purpose.
Publications, services or entertainment that contain or promote obscene matter, as defined in Title 17, section 2911, subsection 1, paragraph D;
Tattoos, as defined by Title 32, section 4201, or body art; or
Retail marijuana and retail marijuana products as defined by Title 7, section 2442.
Penalty for misuse – When a recipient is suspected of using the EBT system to purchase a restricted item or service as defined in f) above, a referral will be made to the Fraud, Investigation and Recovery Unit (FIRU).
When the recipient has, based on clear and convincing documentary evidence as determined by the Department, knowingly purchased a product or service in violation of f) above, the recipient is deemed to have received an overpayment in the amount of the prohibited purchase.
The recipient is also subject to the following penalties:
For the first offense, the recipient shall be disqualified from receiving benefits for a period of 3 months;
For the second offense, the recipient shall be disqualified from receiving benefits for a period of 12 months; and
For the third and subsequent offenses, the recipient shall be disqualified from receiving benefits for a period of 24 months.
When the department has determined that a recipient has violated f) above, the Department must initiate a Fair Hearing on behalf of that recipient. The notice of hearing and fair hearing will be conducted according to the policy in this Chapter.
Restricted Locations – A recipient may not use an EBT card at the locations listed below:
A retail establishment where 50% or more of the gross revenue of the establishment is derived from the sale of liquor;
A gambling facility, except that use of the electronic benefits transfer system is permitted in any portion of the premises of a gambling facility that is set aside separately for the sale primarily of staple foods; and
A retail establishment that provides adult-oriented entertainment in which performers disrobe or perform in an unclothed state for entertainment.
Use of the EBT card at a restricted location listed in h), above will result in an Intentional Program Violation (IPV) and, a referral to the Fraud Investigation Unit for further review and recovery.
Lost, Stolen or Damaged EBT Card
Clients will report lost, stolen or damaged cards to the EBT Customer Service Help Desk by calling the toll free number, 1-800-477-7428.
EBT Help Desk Staff will “status” the card as lost, stolen, or damaged.
After the EBT Help Desk Staff gets identification to appropriately identify the client, a replacement card will be issued this way:
If the client lives at the same address known to DHHS/BFI and the client has enough money in the EBT account to pay for the card replacement fee, the help desk will authorize the replacement card, which will be mailed out on the next DHHS/BFI business day.
The client can continue to use the same PIN or may change the PIN by using the same toll free EBT Help Desk number, or they may go to a local office.
If the client’s address has changed or there is not enough money in the client’s EBT account to pay for the card replacement fee, the EBT Help Desk will not authorize a card replacement. The client will be told to contact a local office to report the new circumstances. After the client’s case record is updated, the client must follow procedures explained in paragraph 1.
EBT Card Replacements and Fees
No fee will be charged for either the original card or the first replacement card within a 12-month period.
The following fees will be charged for the second and subsequent replacement cards within a 12-month period:
2 nd replacement = $1.00 fee 3 rd replacement = $2.00 fee 4 th replacement = $3.00 fee 5 th replacement = $4.00 fee 6 th replacement = $5.00 fee Subsequent replacements = $5.00 fee
The fee must be paid at the time the card is issued. It can be paid by check, money order or through the client’s EBT account. Cash will not be accepted.
Card fees can be waived by Program Administrators or their designee when hardships exists.
END OF CHAPTER
WHOLE FAMILY ECONOMIC SECURITY INITIATIVES:
General: The Department will annually provide a maximum of $2,000,000 from Maine’s Temporary Assistance for Needy Families block grant to community action agencies as defined in 22 M.R.S. §5324 or other community-based organizations to assist parents of minor children in their pursuit of stable employment or education intended to lead to employment.
Organization Qualification: The organization must demonstrate to the Department that it has the resources and capacity to implement evidence-based practices to provide services.
Family Eligibility: Selected vendors may provide services to parents and minor children whose monthly gross household income is less than 200% of the nonfarm income official Federal Poverty Limit.
Current FPL amounts are issued annually by the U.S. Department of Health and Human Services and can be found on the Internet at: https://aspe.hhs.gov/poverty-guidelines.
An individual can also receive a copy of the current FPL amounts by contacting his/her local DHHS office, or by writing to:
OFFICE FOR FAMILY INDEPENDENCE
11 State House Station, 19 Union Street
Augusta, Maine 04333-0011
and requesting a copy. Department staff making eligibility determinations will also have current FPL information and can share that information with an applicant upon request.
Contract requirements and process:
The Department shall select vendors to provide these services.
The Department shall review the contracts annually.
The Department shall include in this annual review the evaluation of:
i. Performance measures;
ii. Participant satisfaction and well-being; and
iii. Fiscal and administrative accountable.
Vendors will be required to demonstrate the items outlined in (4) (b) as a contractual requirement.
LEGAL BASIS: In addition to the basic TANF and PaS programs, the Department of Health and Human Services administers a limited program of Emergency Assistance. The program was originally authorized by the 111th Legislature . In the event of lack of funds as outlined by the Legislature, the program will end.
GENERAL RULE: Payment of services through the Emergency Assistance program is limited to children and their families who are threatened by destitution or homelessness because of emergency situations. The program does not cover all emergencies.
Authorization in the 30 day period may be made for any combination of covered payment or services within the limitations of payment maximums for some services.
The Emergency Assistance program is not a substitute for the locally administered General Assistance program, although it can be a supplement to that program and a potential resource. Eligibility is not dependent upon denial of General Assistance or the complete expenditure of General Assistance benefits prior to application.
There must be a reasonable expectation that the emergency can be alleviated through the use of Emergency Assistance funds.
TIME LIMITS: Payment of services through EA is limited to those services authorized during the 30 days following the date of initial authorization. Applications for families or individuals may be approved only once during any 12 consecutive month period. The twelve month period begins with the day following the day of the initial approval of Emergency Assistance.
Example: Initial Emergency Assistance payment authorized on 1/1/94; twelve month period is 1/2/94 through 1/1/95; family is potentially eligible again on 1/2/95.
Families which have not received Emergency Assistance benefits during the 12 consecutive month period may receive services even if a child living with the family has received services within the 12 month period. In this situation, eligibility and services provided for the child who has received Emergency Assistance during the past 12 months must have been provided while the child was living away from the family, the family's income (and assets) must not have been considered in determining this child's eligibility and another child who is eligible for Emergency Assistance services but has not received them during the 12 month period must be residing with the family.
PROGRAM REQUIREMENTS: In order to be eligible for Emergency Assistance, all of the following criteria must be met:
1. The child must be under the age of 21;
2. The child must be living with an individual described in the TANF and PaS programs as a "specified relative" or must have lived with a specified relative within the six months prior to the date of application. Women in their last trimester of pregnancy who have no other children living with them are potentially eligible. The focus of the Emergency Assistance program is the child.
NOTE: Services may be provided to a child who has been absent from the family for less than 6 months.
NOTE: Services cannot be authorized for the child's family unless the child is living with them at the time of application.
3. The child and family must meet income eligibility requirements. If the child is living alone or with a specified relative other than the child's parent and, if payment is to be made by the Emergency Assistance program only for services authorized for the child, only the child's resources are to be taken into account. If the child is living with parents, the income of the parents must be taken into account.
Income Limit: Payment for services through this program is available to families which do not have income available to provide the needed emergency care of services. For all services provided through the Emergency Assistance program, the following income limits must be met:
a. a family's income must be below 100% of the Federal Poverty Level, or
b. families must receive TANF or PaS, SSI, or Food Supplement Program benefits.
NOTE: Every household member applying for EA must receive at least one of the benefits listed above.
In determining the amount of income available to the family, the same work related disregard including the child care disregard allowed in the TANF and PaS cash programs are used.
The definitions of excluded income used in the TANF and PaS programs apply to the Emergency Assistance program.
4. All bills must be in either the applicant's name or the name of other adults or children listed on the application who meet Emergency Assistance requirements.
5. Refusal, without good cause, of a family member to accept employment or training must not have caused the circumstance requiring Emergency Assistance.
6. Payments will be made only to vendors. No reimbursements or third party payments will be approved. Copies of approvals will be made for the applicant, vendor, DHHS Accounting Office and the case file unless authorized electronically. Applicants will be notified of eligibility decisions in all circumstances.
7. All non-financial eligibility factors of the TANF and PaS cash programs must be met unless excluded below or elsewhere in this Chapter. Excluded requirements of the Emergency Assistance program are:
- Assignment of Rights to Support
- ASPIRE-TANF participation
- Third Party Liability
- Assets
- Lump Sum Income (consider any portion of the lump sum not excluded as described in Chapter III, Lump Sum as an asset)
- Income (see Income Limit and FPL in Appendix)
- Child's Age Limit (under 21 years)
Scope of Service: Assistance will be in the form of vendor payments for current or past expenses. Payment will not be authorized to other governmental or private organizations offering the same or similar services (Red Cross, Salvation Army, municipalities). Applications must be received within 30 days of receipt of the actual disconnection notice, eviction notice, foreclosure notice or lien expiration or after 30 days in situations when the crisis continues to exist. In the case of repairs or replacement the application must be received within 30 days of the date the crisis occurs or after 30 days when the crisis continues to exist. If the request is for special equipment due to handicap, the 30-day rule does not apply.
A tentative agreement has been reached between the vendor, the client and the Department when it is determined the payment will resolve the vendor's dispute. Payment will be authorized if the services have been provided in accordance with the agreement and the vendor has provided the Department with an appropriate bill.
Assistance will be limited to one consecutive 30-day period in any consecutive 12-month period. Although needs and costs may be higher, a maximum limit of $600 per family is established for services described in categories 1 through 5. Additional maximums for particular items or services are identified in later sections.
If assistance reaches the maximum before the consecutive 30-day period expires, eligibility ceases. If the consecutive 30-day period expires, eligibility also ceases, even if the maximum assistance has not been reached.
Assistance shall be used as indicated to cover needs resulting from specific types of emergencies. Evidence that the emergency occurred and details of the situation must be documented in the case record.
1. Disasters: Situations involving disaster such as fire, flood, storm causing damage and/or loss of property and goods.
Assistance may be used to provide or replace necessary household items destroyed or rendered unusable. Some items that may be considered are clothing, repairs or replacement of essential household equipment, repairs of structure (if owned or being purchased by applicant), food, emergency shelter, moving or storage of essential household equipment. This includes plumbing, electrical and carpentry work and rental of new living arrangements including a security deposit if required. Maximum payment is $350.
The applicant, adults and children listed on the application who meet Emergency Assistance/AFDC requirements must be the owner of or purchasing the property which was damaged at the time of the disaster which needs to be repaired or replaced.
Application for assistance must be received within 90 days of the disaster.
Procedure for Emergencies Involving Disasters
a. The estimate from the vendor will be used as a basis for determining which items will be approved for payment.
b. Once approval has been made a copy of the estimate indicating which items have been approved will be sent to the vendor with a letter explaining the Department’s decision.
c. If assistance is requested for plumbing, electrical, carpentry, or other similar work, estimates must be made by a reputable person in the appropriate field of work. Payment will be made only after the work has been completed by a reputable repairman, carpenter, electrician, etc. When necessary, the completion of work and the safe conditions which result are to be verified.
2. Repair/Replace: Situations involving crisis due to inadequate, broken or worn conditions of a well, chimney, septic system, furnace, heating stove, or a related essential service which infringes upon a family's ability to cope with the elements. In these situations the structure, facility or item requiring service must be owned or must be in the process of being purchased by the applicant. Approval will be made for repairs or replacement. No approval will be made for repairs or replacement of property owned by other even though such property is being used by the applicant.
Assistance may be authorized for repair of chimneys, roofs, plumbing, electrical work, furnace or other heating, septic systems and wells. In order to repair or replace heating stoves they must be the primary source of heat and not a back-up system. Maximum payment is $500.
When authorizing the purchase of a stove for heating purposes, the following is needed:
a. A statement from the fire department that the chimney and hook-up are safe and that the existing stove is unsafe and needs replacing;
b. If the request is for repair or replacement of furnace, proof of ownership of the home is needed.
NOTE: Purchase of stoves and furnaces will be limited to no more than one per household in a five year period.
Prior to authorization an estimate of the cost of repairs is required from a reputable dealer or repairman licensed for such services.
Authorization may include estimated costs. However, they must be within the overall maximums listed above.
3. Emergency Housing: Situations involving the need for housing due to condemnation of structure, domestic violence, unsafe or unhealthy conditions for the child(ren) which has been certified by a public official, or actual eviction not caused by misuse of property or other types of willful disturbance by applicant, relatives or their guests. The eligibility worker must contact the landlord to investigate the condemnation or circumstance giving rise to an actual eviction. If the landlord alleges misuse of property or other types of willful disturbance by the applicant or a guest, the eligibility worker will make every reasonable effort to investigate further to determine if the allegation is true. Where the alleged misuse of property has been caused by an abuser in a domestic violence situation, the abused person will not be denied assistance.
In this category of assistance, a maximum of $250 toward back rent, a security deposit on a new rental property, and court costs associated with evictions is allowed.
a. Evictions: When the situation involves an eviction, application must be accompanied by an eviction notice, court eviction order, or statement from the landlord or attorney that an eviction is taking place, or has taken place within the 30 days prior to application or other credible evidence that an eviction (lawful or unlawful) is or has occurred within the 30 days prior.
In instances of eviction, the applicant, other adults or children listed on the application must have the actual tenant/landlord relationship.
If the need for housing is caused by domestic violence, or unsafe or unhealthy conditions, the application must be accompanied by documents necessary to prove the situation.
The reason for the eviction must be established. In a case of nonpayment of rent, if the notice does not specify the date due and amount, the worker will ascertain this information to ensure that the eviction notice will be rescinded even if assistance does not cover all the back rent and the landlord is willing to make arrangements for a plan whereby the applicant will pay the balance in installments or through use of other resources.
b. Security Deposits: Security deposits will only be authorized only in cases described below.
1. There must be a definite landlord/tenant relationship, which can be verified by either a lease, rent receipts, or other credible information and the tenant must be actually facing eviction or must have been evicted within 30 days prior to the date of application.
2. The building is being or has been condemned.
3. The building has not been condemned but it can be verified by a public official that the facility is harmful to the health and physical wellbeing of the child(ren).
4. A lease which requires no written notice expires and the landlord refuses to extend it.
5. Domestic violence has occurred.
6. The rental property must be within the State of Maine.
c. Mortgage Payments: Past due mortgage payments will be paid if the party holding the mortgage assures that the $250.00 will prevent foreclosure even if it does not cover the entire amount due.
Past due real estate taxes will be paid to prevent foreclosure or after foreclosure if the town agrees to quit claim the property back to the client even if the $250.00 doesn't cover the amount due and if the client still lives in the property.
4. Utilities: Situations involving actual or potential shut-off of electricity, gas, bottled gas, or water and sewer bills. Potential shut-off shall means receipt of termination of service notice from the respective utility. Termination of service must be in accord with rules and regulations in Chapter 81, "Rules and Regulations for Disconnection and Deposit Regulations for Residential Utility Services", P.U.C.
In instances of potential or actual disconnection, the utility must be in the applicant's name, or n the name of the adults or children listed on the application who meet Emergency Assistance/AFDC requirements. In the event that the utility is in another person's name, the applying family unit is not responsible for payment of the bill. If the applicant, requests assistance to establish service in their name due to a disconnection of service, assistance may be provided to pay a prior bill in the name of the applicant.
Assistance for sewer bills will be granted at the time the lien put on the property for this purpose is maturing.
In such situations a maximum of $150 will be made toward arrearage of the bill. Approval of payment of the utility expense must be established with the applicant and utility vendor that shut-off will not take place even if the assistance does not cover all the back bill and that arrangements can be made for establishing a plan to pay the balance in installments directly or through use of other resources.
NOTE: In addition, on a utility with an arrearage of less than $150 the client should apply to C.A.P. for benefits before applying for Emergency Assistance. Maximum payment is $150.
NOTE: In the situation where more than one utility is to be disconnected, upon written verification additional assistance for this may be provided up to the $150 maximum not used against the first utility.
Example: $150 maximum payment
- xx authorized payment on first utility
= xxx maximum payment which can be
authorized for the second utility.
5. Special Medical Equipment or Clothing: Situations involving inability to perform daily living functions due to a physical or mental incapacity requiring special clothing or equipment not covered by Medicaid or Vocational Rehabilitation.
In such situations assistance may be authorized for items such as corrective shoes, leg braces, bandages, special stockings, back braces, adjustment of living arrangements, etc. The maximum payment is $250 per individual.
NOTE: Eye glasses are not covered for adults.
Scope of Service: Applications will be available through all Department regional offices and its Central Office. In addition, municipal officials and other social service agencies will be supplied with applications upon request. Such agencies, through assisting client in completing the application, are not required to verify information on the application. Any verification they document will be accepted by the Department.
Eligibility for Emergency Assistance will be determined by a Department of Health and Human Services Eligibility Worker. If clarification is needed, the applicant will be contacted by phone or mail. The applicant will be notified in writing whether he or she is eligible or ineligible. If eligible, notification will state the service and the amount. Hearing rights will also be outlined in the letter.
Approval will be made for one consecutive 30 day period per 12 month period. Decisions shall be made within 10 working days unless the applicant has failed to provide needed verification of information necessary to determine eligibility or asks for the application process to be extended.
Right To Hearing: Any person aggrieved by a decision, act, failure to act or delay in action concerning the application under this chapter shall have the right to an appeal. The same policy and procedure used in the TANF and PaS programs applies to Emergency Assistance with regard to hearings except that a hearing shall be held by the Administrative Hearings Officer within 10 working days following the receipt of an oral or a written request from the applicant for an appeal.
FAMILY HOUSING STABILIZATION PROGRAM
LEGAL BASIS: In addition to the basic TANF and PaS programs, the Department of Health and Human Services administers a limited temporary program called Family Housing Stabilization. This program is authorized through the American Recovery and Reinvestment Act (AARA) and is time limited. The Program will end on 9/30/2010 or when funding is exhausted, whichever occurs first. The Family Housing Stabilization Program is available to eligible clients who have been referred to the Department by the MaineHousing Homeless Diversion and Prevention Program administered as part of the Homelessness Prevention and Rapid Re-Housing Program funded under the American Recovery and Reinvestment Act of 2009.
GENERAL RULE: Payment of services through the Family Housing Stabilization (FHS) Program is limited to children and their families who are at risk of imminent homelessness due to lack of stable housing and lack of housing security. The program does not cover all situations.
In order to meet the definition of imminent risk of homelessness which is needed to qualify for assistance, the applicant must have at least one of the risk factors listed below:
Eviction from a private dwelling – The tenant has received termination notice in the form of either a Notice to Quit or a Summons and Complaint in a forcible entry and detainer action;
Foreclosure from a privately owned dwelling – the homeowner has been served a Writ of Possession issued by the court in a foreclosure proceeding;
Impending termination of a housing arrangement provided by family or friends that is not sustainable;
Discharge within two weeks from an institution in which the person has been a resident for more than 180 days (including prisons, mental health institutions, hospitals) and met the McKinney-Vento definition of homelessness at admission; or
Housing that is not fit for human habitation
Renter – Residency in a rental unit that is not fit for human habitation where the landlord is unwilling or unable to remedy unsafe or unfit living condition(s).
Private Dwellings – Residency in a privately owned dwelling that is not fit for human habitation in a manner that would force the owner to quit the premises within a two-week period.
Examples of unsafe or unfit living conditions include undrinkable water, no heat or too little heat in the winter, an inoperative septic system or a combination of problems, such as leaking ceilings, unsafe heating system, broken windows, and roaches.
Authorization in the eligibility period may be made for any combination of covered payments or services within the limitations of the payment maximum of $2,500 per family.
The FHS Program is not a substitute for the locally administered General Assistance program or for the DHHS Emergency Assistance or Alternative Aid Programs, although it can be a supplement to those programs and a potential resource. Eligibility is not dependent upon denial of General Assistance, Emergency Assistance or Alternative Aid or the complete expenditure of General Assistance, Emergency Assistance or Alternative Aid benefits prior to application.
SUSTAINABILITY STANDARD: There must be a reasonable expectation that the assistance will alleviate the risk of housing instability and that the family will be able to maintain housing security for at least the next six month period after receiving FHS assistance. The determination of the ability to maintain housing for six months following the receipt of assistance will be made by one of the designated agencies for the MaineHousing Homeless Diversion & Prevention Program.
TIME LIMITS: FHS assistance is a once in a lifetime benefit.
PROGRAM REQUIREMENTS: In order to be eligible for FHS, all of the following criteria must be met:
The child must be under the age of 21;
The child must be living with an individual described in the TANF and
PaS programs as a “specified relative”. Women in their last trimester of pregnancy who have no other children living with them are potentially eligible. The focus of the FHS program is to help families with children obtain housing security.
NOTE: Services cannot be authorized for the child’s family unless the child is living with them at the time of application.
The child and family must meet income eligibility requirements. If the child is living with parents, the income of the parents must be taken into account.
Income Limit: Payment for services through this program is available to families which do not have income available to provide the needed services. For all services provided through the FHS program, the following income limits must be met:
a. a family’s income must be below 185% of the Federal Poverty Level, or
b. families must receive TANF or PaS, SSI, or Food Supplement.
NOTE: Every household member applying for FHS must receive at least one of the benefits listed above.
In determining the amount of income available to the family, the same work related disregards, including the child care disregards, allowed in the TANF and PaS cash programs are used.
The definitions of excluded income used in the TANF and PaS programs apply to the Family Housing Stabilization Program.
All bills must be in either the applicant’s name or the name of other adults or children listed on the application who meet FHS requirements.
6. Refusal, without good cause, of a family member to accept employment or training must not have caused the circumstance requiring Family Housing Stabilization benefits.
7. A family in which the adult is under ASPIRE sanction must remedy the sanction and sign a Family Contract Amendment with the Department.
Payments will be made only to vendors. No reimbursements or third party payments will be approved. Payment will not be authorized to other governmental or private organizations offering the same or similar services (Red Cross, Salvation Army, municipalities).
9. All non-financial eligibility factors of the TANF and PaS cash programs must be met unless specifically excluded. Those requirements excluded from consideration in FHS program eligibility include Deprivation, Assignment of Rights to Support, and Third Party Liability. There is no asset limit for this program, and lump sum income (as described in this manual at Chapter III, page 25) where not excluded is considered an asset and therefore not subject to a limit. And as indicated in this chapter in #1 above, the child must be under age 21, and the income limits for the FHS program are specified in #4 above.
SCOPE OF SERVICE: Assistance will be in the form of vendor payments for current or past expenses.
A tentative agreement has been reached between the vendor, the client and the Department when it is determined the payment will resolve the housing issue. Payment will be authorized if the services have been provided in accordance with the agreement and when the vendor has provided the Department with an appropriate bill.
Although needs and costs may be higher, a maximum limit of $2,500 per family is established for services directly related to housing expenses. Payments to vendors may include, but are not limited to, payment for rent or mortgage, including arrearages; security deposits necessary to secure housing; delinquent property taxes; liens; plumbing, electrical, carpentry, or other similar work; the repair or replacement of chimneys, roofs, windows, doors, major appliances, furnace or other heating system, septic system or wells; and any other expenses necessary to sustain the housing security of the family.
Payment of services through the Housing Stabilization Program is limited to those services authorized during the 30 days following the date of initial authorization. Bills must be received by the Department within sixty (60) days of the date of initial authorization.
If assistance is requested for plumbing, electrical, carpentry, or other similar work, estimates must be made by a reputable person in the appropriate field of work. Payment will be made only after the work has been completed by a reputable repairman, carpenter, electrician, etc. The Department may request verification that the work has been completed and has resulted in safe conditions.
Expenses related to transportation are not covered by this program.
Expenses for repair, replacement or eviction caused by misuse of property or other types of willful disturbance by the applicant, relatives or their guests are not covered by this program.
If assistance reaches the maximum before the eligibility period expires, eligibility ceases.
PROCEDURES:
The applicant family makes contact with one of the designated agencies for the MaineHousing Homeless Diversion & Prevention Program administered as part of the Homelessness Prevention and Rapid Re-Housing Program funded under the American Recovery and Reinvestment Act of 2009.
Housing Stability Specialists, also called case managers, located at the designated agencies, will assess families for program eligibility and work together with the family to connect with all resources that will help the family stabilize housing.
Housing Stability Specialists will make determination that if the family has services provided, the family will have sufficient income and resources to cover expenses for the following 6 months.
Resources that the family needs to connect with might include mortgage or rental assistance, weatherization, heating system repairs, credit counseling, and any other resource directly related to housing stabilization that will assist the family.
Once all other resources are exhausted, the stability specialist will refer the applicant to DHHS for additional assistance. DHHS will make the final determination of a family’s eligibility for the Family Housing Stabilization Program.
LEGAL BASIS:
The 117th Legislature authorized the Department to establish an Alternative Aid program. 22 M.R.S. § 3763(8) requires the department to provide alternative aid to eligible applicants who seek short-term assistance in order to obtain or retain employment; and establish eligibility requirements. It limits alternative aid to no more than 3 times the value of the monthly TANF grant and aid no more than once during any 12-month period. It requires a family who reapplies for TANF within three months of receiving alternative aid to repay any alternative aid received in excess of the amount that the family would have received on TANF via the method used for the repayment of unintentional overpayments in the TANF program.
B. GENERAL RULE:
The Alternative Aid voucher payment is assistance to applicants who seek short-term help to obtain or retain employment. The intent of the program is to help families remain self-supporting by providing voucher payments worth up to three months of the TANF benefits for which they are eligible. The expectation is that by providing a larger amount of benefits in a shorter time period, the family is able to obtain or retain a job and will not become dependent on the TANF program.
Assistance includes, but is not limited to, help with car repairs, child care, resolution of a housing-related problem, uniforms, or other items necessary to assist a person in obtaining or retaining employment.
C. PARTICIPANTS:
Applicants statewide may volunteer to receive Alternative Aid. Alternative Aid is not available to families who are currently receiving TANF.
D. PAYMENT:
The Department shall pay vendor payment(s) for the application month and the two subsequent months for which the family is eligible. The Department shall authorize benefits within 30 days of application. No cash benefit is paid to the family. Vendor payments are authorized after the expense has been confirmed.
E. ELIGIBILITY REQUIREMENTS:
The rules that govern the TANF payment, including the asset limit, income limit and the budgeting process, apply to Alternative Aid assistance with the following exceptions:
(1) The initial gross income test is 133% of the Federal Poverty Level.
(2) Child support payments received minus the first $50, are counted as unearned income in determining eligibility for and the amount of the Alternative Aid benefit. (See item e.)
(3) The Alternative Aid benefit may be issued only once in any 12 consecutive month period. The 12-month period begins with the day following the day of the initial approval of Alternative Aid.
(4) The specified relative or parent must be employed or looking for work.
(5) The family is not required to assign child support, comply with ASPIRE-TANF requirements, or participate in a TANF orientation meeting.
(6) Receipt of Alternative Aid Assistance does not count towards the 60 month time limit.
(7) When the family’s income passes the pretests, the wages which would count in the grant calculation of TANF or PaS benefits are excluded income in the grant calculation of Alternative Aid Assistance.
F. receipt of alternative Aid does not count as receipt of TANF:
Periods of receipt of Alternative Aid do not constitute receipt of TANF benefits for purposes of eligibility for Transitional Food Assistance, TANF Earnings Food Benefit, Transitional Child Care, or Transitional Transportation.
G. Prohibitions against Duplicate Participation:
If during the 3 month eligibility period in which a family is receiving the Alternative Aid benefit the family applies for and is determined eligible for TANF or PaS, the family must repay any Alternative Aid received for any period which was covered by both Alternative Aid and TANF. The repayment method is the same as that used for the repayment of unintentional overpayments in the TANF program.
Families who receive Working Families Supplement Benefit (WSB) cannot receive Alternative Aid during the same time. WSB recipients can apply for Alternative Aid. If a WSB recipient applies for Alternative Aid and is found eligible, WSB can be suspended during the period of Alternative Aid eligibility and shall be reinstated after the eligibility period has ended if otherwise eligible.
H. INFORMING TANF APPLICANTS:
The Department shall explain Alternative Aid to all TANF applicants. Families may apply for Alternative Aid if they think the program will help them retain or obtain employment.
A family may apply for Alternative Aid instead of TANF by completing an application and consent form agreeing to comply with the terms of Alternative Aid.
LEGAL BASIS: The 118th Legislature authorized the Department to establish a student financial aid program based on need for up to 2000 participants known as the Parents as Scholars Program, (PaS) to aid needy students who have dependent children and who are matriculating in post-secondary undergraduate 2-year and 4-year degree-granting education programs. Enrollees in the program are provided with a package of student aid that includes aid for living expenses in an amount equivalent to TANF recipients. A family that ceases to receive aid under this chapter as a result of increased child support or increased hours of, or increased income from, employment is eligible to receive transitional support services. The program must be supported with funds other than federal block grant funds provided under the United States Social Security Act, Title IV-A. The program begins 8/1/97.
The 121st Legislature enacted law to allow the Department to use the Federal TANF Block Grant to fund twelve months of a family's PaS benefits beginning on or after July 1, 2003.
GENERAL RULE: Recipient and applicant families who qualify for TANF assistance on or after 6/20/97 may apply to participate in the PaS program instead of TANF. Individuals with marketable bachelor’s degrees are ineligible for the Parents as Scholars.
PROGRAM REQUIREMENTS: Eligibility for and the amount of assistance for PaS is determined in accordance with all the eligibility criteria and procedures used in the TANF program including assignment of child support, with the following exception:
1. Individuals applying to the program must be assessed in accordance with the provisions of the ASPIRE-TANF/PaS rules. To the extent that program resources and space permit, enrollment in the program must be granted if the ASPIRE-TANF/PaS assessment results in findings as follows:
a. the individual does not possess the necessary skills to obtain employment that will enable that individual to support a family at 85% of the median family income in the State for a family of the same size;
b. considering potential employment opportunities and local labor market conditions, the postsecondary education sought by the individual will significantly improve the ability of the family to be self-supporting; and
the individual has the aptitude to complete the proposed post-secondary program successfully.
NOTE: PaS participants are subject to the 60-month TANF time limit regardless of the funding source of the benefits. PaS participants may be eligible for a temporary extension of benefits if they meet the requirements listed in Chapter 1, Time Limits.
PARTICIPATION REQUIREMENTS: An enrollee must participate in a combination of education, training, study or work-site experience for an average of 20 hours per week in the first 24 months of the program. Aid under this chapter may continue beyond 24 months if the enrollee remains in an educational program and agrees to participate in either of the following options which are the result of Legislative action which becomes effective on September 18, 1999:
A. Fifteen hours per week of work-site experience in addition to other education, training or study; or
B. A total of 40 hours of education, training, study or work-site experience.
The Department must present both options to enrollees and permit them to choose either option. For the purpose of this subsection, work-site experience includes, but is not limited to, paid employment, work study, practicums, internships, clinical placements, laboratory or field work directly related to the enrollee's employment goal or any other work activities that, as determined by the Department, will enhance the enrollee's employability in the enrollee's field. In the last semester of the enrollee's educational program, work-site experience may also include resume preparation, employment research, interviews and other activities related to job placement.
The Department must make reasonable adjustments in the participation requirements in this subsection for good cause.
Good Cause:
For the purpose of this subsection, "good cause" means circumstances in which the required participation would cause the enrollee to seriously compromise academic performance. "Good cause" includes, but is not limited to:
1. a verifiable need to take care of a family member with special needs;
2. a physical or mental health problem, illness, accident, death; or
3. a serious personal or family problem that necessitates reduced participation or time off from education, training or work.
An enrollee receiving aid under this chapter must make satisfactory progress in the enrollee's educational program. Rules defining satisfactory academic progress are found in the ASPIRE-TANF manual. The Department may not disapprove an educational plan based solely on the length of the educational program.
The Working Families Supplement is part of the Temporary Assistance for Needy Families (TANF) program and provides a food benefit to households consisting of employed parents with minor children who receive food supplement benefits and who meet TANF work requirements. The goal of the benefit is to help transition these families to self-sufficiency.
This benefit is a food assistance benefit, not a cash benefit, and may be used only as permitted by Maine’s Food Supplement Program.
Eligibility Criteria
Eligibility is determined automatically on a monthly basis based on data in the Automated Client Eligibility System (ACES). For the household to receive the benefit, data in ACES must show that during the benefit month the household:
Received food supplement benefits; and
Did not include a member who is also receiving TANF cash assistance; and
Included a minor child whose biological or adoptive parent(s) reside in the same household; and
Met the following work requirements:
One parent household with a child(ren) over the age of six – 30 hours per week.
Single parent with a child under age six – 20 hours per week.
Two parent household – 35 hours per week or 55 hours if receiving federally funded childcare subsidies; and
Except as provided above, all other TANF requirements or limitations including time limits on receipt of TANF, child support assignment and participation with ASPIRE, do not apply to this program.
Amount of Benefit
The amount of the Working Families Supplement benefit will be determined by the Department and will be the same amount for each eligible household. No more than one benefit may be issued to a household per month. The Department may, at any time, suspend the Working Family Supplement or reduce the benefit amount.
Notice of Eligibility
Eligible households will receive monthly notice of their eligibility for the Working Families Supplement. When a household that has previously received the benefit becomes ineligible, a notice will be sent informing the household of the change in its eligibility, the reason the change, and the right to appeal.
Issuance
The Working Families Supplement benefit will be issued to eligible households on their existing food supplement electronic benefit transfer (EBT) card. The benefit will be issued during the first five business days of the month based on the prior month’s work hours.
Table of Percentages for First Month Payment
28 Day | Month Percent | 29 Day | Month Percent | 30 Day | Month Percent | 31 Day | Month Percent 1 | 100.00 | 1 | 100.00 | 1 | 100.00 | 1 | 100.00 2 | 96.43 | 2 | 96.55 | 2 | 96.67 | 2 | 96.77 3 | 92.86 | 3 | 93.10 | 3 | 93.33 | 3 | 93.55 4 | 89.29 | 4 | 89.66 | 4 | 90.00 | 4 | 90.32 5 | 85.71 | 5 | 86.21 | 5 | 86.67 | 5 | 87.10 6 | 82.14 | 6 | 82.76 | 6 | 83.33 | 6 | 83.87 7 | 78.57 | 7 | 79.31 | 7 | 80.00 | 7 | 80.65 8 | 75.00 | 8 | 75.86 | 8 | 76.67 | 8 | 77.42 9 | 71.43 | 9 | 72.41 | 9 | 73.33 | 9 | 74.19 10 | 67.86 | 10 | 68.97 | 10 | 70.00 | 10 | 70.97 11 | 64.29 | 11 | 65.52 | 11 | 66.67 | 11 | 67.74 12 | 60.71 | 12 | 62.07 | 12 | 63.33 | 12 | 64.52 13 | 57.14 | 13 | 58.62 | 13 | 60.00 | 13 | 61.29 14 | 53.57 | 14 | 55.17 | 14 | 56.67 | 14 | 58.06 15 | 50.00 | 15 | 51.72 | 15 | 53.33 | 15 | 54.84 16 | 46.43 | 16 | 48.28 | 16 | 50.00 | 16 | 51.61 17 | 42.86 | 17 | 44.83 | 17 | 46.67 | 17 | 48.39 18 | 39.29 | 18 | 41.38 | 18 | 43.33 | 18 | 45.16 19 | 35.71 | 19 | 37.93 | 19 | 40.00 | 19 | 41.94 20 | 32.14 | 20 | 34.48 | 20 | 36.67 | 20 | 38.71 21 | 28.57 | 21 | 31.03 | 21 | 33.33 | 21 | 35.48 22 | 25.00 | 22 | 27.59 | 22 | 30.00 | 22 | 32.26 23 | 21.43 | 23 | 24.14 | 23 | 26.67 | 23 | 29.03 24 | 17.86 | 24 | 20.69 | 24 | 23.33 | 24 | 25.81 25 | 14.29 | 25 | 17.24 | 25 | 20.00 | 25 | 22.58 26 | 10.71 | 26 | 13.79 | 26 | 16.67 | 26 | 19.35 27 | 7.14 | 27 | 10.34 | 27 | 13.33 | 27 | 16.13 28 | 3.57 | 28 | 6.90 | 28 | 10.00 | 28 | 12.90 29 | 3.45 | 29 | 6.67 | 29 | 9.68 30 | 3.33 | 30 | 6.45 31 | 3.2 3
Standard of Need and Maximum Grant Amounts
For Special Need Housing Households, add $300 to the Standard of Need and Basic Max Grant amounts for the appropriate household size.
FFY 2022 (October 2021-September 2022)
ADULT INCLUDED NUMBER IN HH | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | ADD STANDARD OF NEED | 362 | 569 | 763 | 960 | 1,153 | 1,348 | 1,544 | 1,740 | 195 BASIC MAX GRANT | 298 | 469 | 628 | 791 | 948 | 1,108 | 1,270 | 1,431 | 160 CHILD ONLY NUMBER IN HH | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | ADD STANDARD OF NEED | 214 | 409 | 605 | 798 | 995 | 1,190 | 1,385 | 1,579 | 195 BASIC MAX GRANT | 178 | 339 | 500 | 657 | 820 | 979 | 1,140 | 1,299 | 160
FFY 2023 (October 2023-September 2023)
ADULT INCLUDED NUMBER IN HH | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | ADD STANDARD OF NEED | 379 | 597 | 800 | 1,006 | 1,209 | 1,414 | 1,619 | 1,824 | 204 BASIC MAX GRANT | 315 | 497 | 665 | 837 | 1,004 | 1,174 | 1,345 | 1,515 | 169 CHILD ONLY NUMBER IN HH | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | ADD STANDARD OF NEED | 224 | 429 | 634 | 837 | 1,043 | 1,247 | 1,452 | 1,656 | 204 BASIC MAX GRANT | 188 | 359 | 529 | 696 | 868 | 1,036 | 1,207 | 1,376 | 169
FFY 2024 (October 2023-September 2024)
ADULT INCLUDED NUMBER IN HH | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | ADD STANDARD OF NEED | 407 | 640 | 858 | 1,079 | 1,297 | 1,516 | 1,736 | 1,956 | 219 BASIC MAX GRANT | 343 | 540 | 723 | 910 | 1,092 | 1,276 | 1,462 | 1,647 | 184 CHILD ONLY NUMBER IN HH | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | ADD STANDARD OF NEED | 241 | 460 | 680 | 897 | 1,119 | 1,338 | 1,557 | 1,775 | 219 BASIC MAX GRANT | 205 | 390 | 575 | 756 | 944 | 1,127 | 1,312 | 1,495 | 184
FFY 2025 (October 2024-September 2025)
ADULT INCLUDED NUMBER IN HH | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | ADD STANDARD OF NEED | 489 | 769 | 1,030 | 1,296 | 1,557 | 1,820 | 2,085 | 2,349 | 263 BASIC MAX GRANT | 425 | 669 | 895 | 1,127 | 1,352 | 1,580 | 1,811 | 2,040 | 228 CHILD ONLY NUMBER IN HH | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | ADD STANDARD OF NEED | 290 | 553 | 817 | 1,077 | 1,344 | 1,607 | 1,870 | 2,131 | 263 BASIC MAX GRANT | 254 | 483 | 712 | 936 | 1,169 | 1,396 | 1,625 | 1,851 | 228
FFY 2026 (October 2025-September 2026)
ADULT INCLUDED NUMBER IN HH | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | ADD STANDARD OF NEED | 500 | 786 | 1,052 | 1,324 | 15,91 | 1,860 | 2,130 | 2,400 | 269 BASIC MAX GRANT | 436 | 686 | 917 | 1,155 | 1,386 | 1,620 | 1,856 | 2,091 | 234 CHILD ONLY NUMBER IN HH | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | ADD STANDARD OF NEED | 296 | 565 | 835 | 1,100 | 1,373 | 1,642 | 1,911 | 2,177 | 269 BASIC MAX GRANT | 260 | 495 | 730 | 959 | 1,198 | 1,431 | 1,666 | 1,897 | 234
WORKSHEET FOR CALCULATING TCC PARENT FEES AND SUBSIDY PAYMENTS
Effective February 5, 2023 through February 3, 2024
WEEKLY GROSS INCOME BY FAMILY SIZE % of FPL to 250% | % of Weekly Gross Income | 1 | 2 | 3 | 4 Up to 25% | 2% | 0 – 71 | 0 – 96 | 0 – 121 | 0 – 146 26 to 50% | 4% | 71.01 – 142 | 96.01 – 192 | 121.01 – 241 | 146.01 – 291 51 to 75% | 5% | 142.01 – 212 | 192.01 – 287 | 241.01 – 362 | 291.01 – 437 76 to 100% | 6% | 212.01 – 283 | 287.01 – 383 | 362.01 – 482 | 437.01 – 582 101 to 125% | 8% | 283.01 – 354 | 383.01 – 478 | 482.01 – 603 | 582.01 – 727 126 to 150% | 9% | 354.01 – 424 | 478.01 – 574 | 603.01 – 723 | 727.01 – 873 151 to 200% | 10% | 424.01 – 566 | 574.01 – 765 | 723.01 – 964 | 873.01 – 1,163 201 to 250% | 10% | 566.01 – 707 | 765.01 – 956 | 964.01 – 1,205 | 1,163.01 – 1,454 5 | 6 | 7 | 8 Up to 25% | 2% | 0 - 171 | 0 – 196 | 0 – 221 | 0 – 245 26 to 50% | 4% | 171.01 – 341 | 196.01 – 391 | 221.01 – 441 | 245.01 – 490 51 to 75% | 5% | 341.01 – 511 | 391.01 – 586 | 441.01 – 661 | 490.01 – 735 76 to 100% | 6% | 511.01 – 682 | 586.01 – 781 | 661.01 – 881 | 735.01 – 980 101 to 125% | 8% | 682.01 – 852 | 781.01 – 976 | 881.01 – 1,101 | 980.01 – 1,225 126 to 150% | 9% | 852.01 – 1,022 | 976.01 – 1,172 | 1,101.01 – 1,321 | 1,225.01 – 1,470 151 to 200% | 10% | 1,022.01 – 1,363 | 1,172.01 – 1,562 | 1,321.01 – 1,761 | 1,470.01 – 1,960 201 to 250% | 10% | 1,363.01 – 1,703 | 1,562.01 – 1,952 | 1,761.01 – 2,201 | 1,960.01 – 2,450 9 | 10 | 11 | 12 Up to 25% | 2% | 0 – 270 | 0 – 295 | 0 – 320 | 0 – 345 26 to 50% | 4% | 270.01 – 540 | 295.01 – 590 | 320.01 – 640 | 345.01 – 690 51 to 75% | 5% | 540.01 – 810 | 590.01 – 885 | 640.01 – 960 | 690.01 – 1,034 76 to 100% | 6% | 810.01 – 1,080 | 885.01 – 1,180 | 960.01 – 1,279 | 1,034.01 – 1,379 101 to 125% | 8% | 1,080.01 – 1,350 | 1,180.01 – 1,474 | 1,279.01 – 1,599 | 1,379.01 – 1,723 126 to 150% | 9% | 1,350.01 – 1,620 | 1,474.01 – 1,769 | 1,599.01 – 1,919 | 1,723.01 – 2,068 151 to 200% | 10% | 1,620.01 – 2,160 | 1,769.01 – 2,359 | 1,919.01 – 2,558 | 2,068.01 – 2,757 201 to 250% | 10% | 2,160.01 – 2,699 | 2,359.01 – 2,948 | 2,558.01 – 3,198 | 2,757.01 – 3,446 9 | 10 | 11 | 12 Up to 25% | 2% | 0 – 270 | 0 – 295 | 0 – 320 | 0 – 345 26 to 50% | 4% | 270.01 – 540 | 295.01 – 590 | 320.01 – 640 | 345.01 – 690 51 to 75% | 5% | 540.01 – 810 | 590.01 – 885 | 640.01 – 960 | 690.01 – 1,034 76 to 100% | 6% | 810.01 – 1,080 | 885.01 – 1,180 | 960.01 – 1,279 | 1,034.01 – 1,379 101 to 125% | 8% | 1,080.01 – 1,350 | 1,180.01 – 1,474 | 1,279.01 – 1,599 | 1,379.01 – 1,723 126 to 150% | 9% | 1,350.01 – 1,620 | 1,474.01 – 1,769 | 1,599.01 – 1,919 | 1,723.01 – 2,068 151 to 200% | 10% | 1,620.01 – 2,160 | 1,769.01 – 2,359 | 1,919.01 – 2,558 | 2,068.01 – 2,757 201 to 250% | 10% | 2,160.01 – 2,699 | 2,359.01 – 2,948 | 2,558.01 – 3,198 | 2,757.01 – 3,446
Effective February 4, 2024 June 03, 2024
WEEKLY GROSS INCOME BY FAMILY SIZE % of FPL to 250% | % of Weekly Gross Income | 1 | 2 | 3 | 4 Up to 25% | 2% | 0 – 73 | 0 – 100 | 0 – 126 | 0 – 152 26 to 50% | 4% | 73.01 – 146 | 100.01 – 199 | 126.01 – 251 | 152.01 – 303 51 to 75% | 5% | 146.01 – 219 | 199.01 – 298 | 251.01 – 376 | 303.01 – 454 76 to 100% | 6% | 219.01 – 292 | 298.01 – 397 | 376.01 – 501 | 454.01 – 605 101 to 125% | 8% | 292.01 – 365 | 397.01 – 496 | 501.01 – 626 | 605.01 – 756 126 to 150% | 9% | 365.01 – 438 | 496.01 – 595 | 626.01 – 751 | 756.01 – 907 151 to 200% | 10% | 438.01 – 584 | 595.01 – 793 | 751.01 – 1,001 | 907.01 – 1,210 201 to 250% | 10% | 584.01 – 729.76 | 793.01 – 990.46 | 1,001.01 – 1,251.16 | 1,210.01 – 1,511.62 5 | 6 | 7 | 8 Up to 25% | 2% | 0 - 178 | 0 – 204 | 0 – 230 | 0 – 256 26 to 50% | 4% | 178.01 – 355 | 204.01 – 407 | 230.01 – 459 | 256.01 – 511 51 to 75% | 5% | 355.01 – 532 | 407.01 – 610 | 459.01 – 689 | 511.01 – 767 76 to 100% | 6% | 532.01 – 710 | 610.01 – 814 | 689.01 – 918 | 767.01 – 1,022 101 to 125% | 8% | 710.01 – 887 | 814.01 – 1,017 | 918.01 – 1,147 | 1,022.01 – 1,278 126 to 150% | 9% | 887.01 – 1,064 | 1,017.01 – 1,220 | 1,147.01 – 1,377 | 1,278.01 – 1,533 151 to 200% | 10% | 1,064.01 – 1,419 | 1,220.01 – 1,627 | 1,377.01 – 1,835 | 1,533.01 – 2,044 201 to 250% | 10% | 1,419.01 – 1,772.32 | 1,627.01 – 2,033.02 | 1,835.01 – 2,293.72 | 2,044.01 – 2,554.41 9 | 10 | 11 | 12 Up to 25% | 2% | 0 – 282 | 0 – 308 | 0 – 334 | 0 – 360 26 to 50% | 4% | 282.01 – 564 | 308.01 – 616 | 334.01 – 668 | 360.01 – 720 51 to 75% | 5% | 564.01 – 845 | 616.01 – 923 | 668.01 – 1,001 | 720.01 – 1,080 76 to 100% | 6% | 845.01 – 1,127 | 923.01 – 1,231 | 1,001.01 – 1,335 | 1,080.01 – 1,439 101 to 125% | 8% | 1,127.01 – 1,408 | 1,231.01 – 1,538 | 1,335.01 – 1,669 | 1,439.01 – 1,799 126 to 150% | 9% | 1,408.01 – 1,690 | 1,538.01 – 1,846 | 1,669.01 – 2,002 | 1,799.01 – 2,159 151 to 200% | 10% | 1,690.01 – 2,253 | 1,846.01 – 2,461 | 2,002.01 – 2,670 | 2,159.01 – 2,878 201 to 250% | 10% | 2,253.01 – 2,815.11 | 2,461.01 – 3,075.58 | 2,670.01 – 3,336.27 | 2,878.01 – 3,596.97
FEDERAL POVERTY LEVELS
Federal Poverty Levels are updated periodically in the Federal Register by the U.S. Department of Health and Human Services under the authority of 42 U.S.C. § 9902(2) and can be found on the Internet at: https://aspe.hhs.gov/poverty-guidelines.
An individual can also receive a copy of the current FPL amounts by contacting their local DHHS office, or by writing to:
OFFICE FOR FAMILY INDEPENDENCE
11 State House Station, 109 Capitol Street
Augusta, Maine 04333-0011
and requesting a copy. Department staff making eligibility determinations also have current FPL information and can share that information with an applicant upon request.
The market rate caps that apply to Transitional Child Care are updated periodically by the Maine Department of Health and Human Services Office of Child and Family Services under the authority of 22 M.R.S. § 3737(4) and regulation at 10-148 C.M.R. ch. 6 §§ 5 and 11. They may be found at: maine.gov/dhhs/ocfs.
RELATIONSHIPS
5.| great-great-great-grandparent
|
4.| great-great-grandparent
|Ì
3.| great-grandfather/grandmother 5. great-granduncle/
| grandaunt
|Ì
2.| grandfather/mother 4. granduncle/grandaunt
| |
| 5. 1st cousin (once removed)
|
|Ì
1.| father/mother 3. uncle/aunt
| |
| 4. 1st cousin
| |
| 5. 1st cousin (once removed)
|
|Ì
| self 2. brother/sister
| |
1.| son/daughter 3. nephew/niece
| |
2.| grandson/daughter 4. grandnephew/niece
| |
3.| great grandson/daughter 5. great-grandnephew/niece
|
4.| great-great grandchild
|
5.| great-great-great grandchild
STATUTORY AUTHORITY: 22 M.R.S. §§ 42(1), 3762
AMENDED:
November 14, 2018 – filing 2018-244
December 22, 2019 – filing 2019-243
April 29, 2020 – filing 2020-098
October 01, 2021 – filing 2021-191
December 10, 2022 – filing 2022-234
June 04, 2024 – filing 2024-135
September 01, 2024 – filing 2024-208
October 13, 2024 – filing 2024-233
January 13, 2025 – filing 2025-003
July 01, 2025 – filing 2025-137
November 02, 2025 – filing 2025-215
November 30, 2025 – filing 2025-231; reposted December 8, 2025 following accessibility check
APAO ACCESSIBILITY CHECK: December 8, 2025 (no issues detected)
HH Size Grant Type FFY 2022 FFY 2023 FFY 2024 FFY 2025 FFY 2026 Oct 21 – Sep 22 Oct 22 – Sep 23 Oct 23 – Sep 24 Oct 24 – Sep 25 Oct 25 – Sept 26 1 Adult Included SON $362 $379 $407 $489 $500 Max Grant $298 $315 $343 $425 $436 Child Only SON $214 $224 $241 $290 $296 Max Grant $178 $188 $205 $254 $260 2 Adult Included SON $569 $597 $640 $769 $786 Max Grant $469 $497 $540 $669 $686 Child Only SON $409 $429 $460 $553 $565 Max Grant $339 $359 $390 $483 $495 3 Adult Included SON $763 $800 $858 $1,030 $1,052 Max Grant $628 $665 $723 $895 $917 Child Only SON $605 $634 $680 $817 $835 Max Grant $500 $529 $575 $712 $730 4 Adult Included SON $960 $1,006 $1,079 $1,296 $1,324 Max Grant $791 $837 $910 $1,127 $1,155 Child Only SON $798 $837 $897 $1,077 $1,100 Max Grant $657 $696 $756 $936 $959 5 Adult Included SON $1,153 $1,209 $1,297 $1,557 $1,591 Max Grant $948 $1,004 $1,092 $1,352 $1,386 Child Only SON $995 $1,043 $1,119 $1,344 $1,373 Max Grant $820 $868 $944 $1,169 $1,198 6 Adult Included SON $1,348 $1,414 $1,516 $1,820 $1,860 Max Grant $1,108 $1,174 $1,276 $1,580 $1,620 Child Only SON $1,190 $1,247 $1,338 $1,607 $1,642 Max Grant $979 $1,036 $1,127 $1,396 $1,431 7 Adult Included SON $1,544 $1,619 $1,736 $2,085 $2,130 Max Grant $1,270 $1,345 $1,462 $1,811 $1,856 Child Only SON $1,385 $1,452 $1,557 $1,870 $1,911 Max Grant $1,140 $1,207 $1,312 $1,625 $1,666 8 Adult Included SON $1,740 $1,824 $1,956 $2,349 $2,400 Max Grant $1,431 $1,515 $1,647 $2,040 $2,091 Child Only SON $1,579 $1,656 $1,775 $2,131 $2,177 Max Grant $1,299 $1,376 $1,495 $1,851 $1,897 Add Member Adult Included SON $195 $204 $219 $263 $269 Max Grant $160 $169 $184 $228 $234 Child Only SON $195 $204 $219 $263 $269 Max Grant $160 $169 $184 $228 $234 For Special Need Housing Households, add $300 to each figure.
Appendix A
Medicare and the Buy-In Process
Medicare (Title 18 of the Social Security Act) is a health program administered by the Centers for Medicare and Medicaid Services (CMS). Coverage is available to nearly everyone over age 65 and those who have been receiving Social Security Benefits as disabled for twenty-four consecutive months.
Medicare Part "A" provides hospital, hospice and skilled nursing facility benefits. It is available without charge to individuals who have worked a certain number of quarters where FICA deductions are mandated. People who are not eligible automatically may enroll by paying a monthly premium.
Medicare Part "B" is optional medical insurance for which everyone enrolling must pay a monthly premium. Most individuals pay the same amount but when enrollment in Part B is postponed, individuals pay a different rate. There is an increase in the premium for each year of delay in enrolling in Medicare Part B. Part "B" assists in payments for doctors, outpatient hospital care, therapy, ambulance and laboratory services.
Both parts of Medicare have deductibles and coinsurance charges which are the responsibility of the individual, although private insurance plans (Medigap) may be purchased which cover these payment gaps.
The following groups of individuals and couples are provided with additional benefits by Medicaid when enrolled in Medicare:
Payment of Part A | Payment of Part B | Payment of Medicare Deductible & Co-Ins. SSI and State Supplement Recipients | X | X Pickle Amendment | X | X Qualified Medicare Beneficiaries (QMB) | X | X | X Qualified Disabled and Working Individual (QDWI) | X Specified Low Income Medicare Beneficiaries (SLMB) | X Qualifying Individuals (QI) Part 1 | X
Aside from Medicare Parts A and B there is Medicare Part D which is a prescription drug benefit through private insurance companies. People who are enrolled in Medicare Buy-In have reduced costs for their medications under Medicare Part D.
The state payment for Medicare premiums is done with a monthly data exchange between the State and Federal governments. There is usually a delay between the time an individual is eligible for the buy-in and the time the buy-in begins. During this time, the individual continues to have the premium deducted from their Social Security or Railroad retirement check. Once the buy-in begins, the individual receives the gross Social Security Benefit. They are reimbursed by Social Security or Railroad retirement for the premium collected during any delay period.
Appendix B
Calculation for Substantial Gainful Activities (SGA)
and Impairment Related Work Expenses (IRWE)
To compute SGA earnings and costs of certain items and services needed to work and related to medical impairment will be deducted from the monthly average gross earnings. These costs are allowable even though the items and services are also used for daily living needs in addition to work, unless otherwise stated below. The costs for each item must be the responsibility of the disabled individual. Actual or potential reimbursements from another source will reduce the allowable deduction.
Example:
Individual purchases crutches for $80.00
Reimbursement from another source - $64.00
Allowable cost $16.00
Allowable Expenses for Consideration
Attendant Care Services - Only that portion of cost associated with assistance:
traveling to and from work:
with personal functions while at work (such as eating and toileting):
with work related functions (such as reading, communicating): and
with personal functions at home for work (such as dressing, administering medications).
Note: Attendant care services may be paid to a family member only if that person suffered an economic loss by ending this job or other employment in order to perform these services. The family member can be related by blood, marriage, or adoption, and need not live with the disabled person.
Medical Devices - This item includes durable equipment (such as canes, wheelchairs, crutches).
Prosthetic Devices (such as artificial limbs).
Work Related Equipment specifically designed to accommodate an impairment (such as typewriters and telecommunication devices for deafness).
Residential Modifications:
Outside - For individuals employed away from home, changes may be made to the outside of the home to permit transportation to work (such as the installation of an exterior ramp for a wheelchair confined person or special railing or pathways for a person requiring crutches).
Inside - If an individual is employed at home, costs of modifying the inside of the home is allowed to create a work space to accommodate the individual's impairment. Only those expenses associated directly with the work area will be allowed, (such as the enlargement of the doorway leading to the work area).
Note: If the cost can be deducted as a business expense for the IRS, then it cannot be deducted in this calculation.
Non-medical Appliances and Equipment - Appliances and equipment specifically prescribed by a physician as essential for control of the impairment. Essential means the item must be one that if not available would cause immediate adverse impact on the individual's ability to function in work activity. (such as the need for an electric air cleaner for an individual who has severe respiratory disease and must work in a purified air environment).
Drugs and Medical Services - including diagnostic procedures to control medical impairments. These items must be prescribed or utilized to reduce or eliminate symptoms of the impairment or to slow down its progression. The diagnostic procedures must be performed to ascertain how the impairment is progressing or to determine what type of treatment is needed (such as anticonvulsant drugs for epilepsy, antidepressant drugs for mental disorders, radiation treatments or chemotherapy for cancer patients). Items or services not directly related to the impairment are not allowable deductions (such as routine annual physical exams, optician services when the impairment is not visual and dental checkups).
Medical Supplies - Medical items utilized for work and directly related to the impairment. (such as catheters, bandages, irrigating kits and face masks).
Transportation - Payments for transportation are limited to the following:
Own Vehicle
If the individual's impairment necessitates a modified vehicle needed for travel to work, modifications must be critical to the individual's operation or use of the vehicle and directly related to the impairment. The cost of the modifications is deductible but not the cost of the vehicle.
If the impairment prevents use of public transportation to and from work, a physician must verify that the need to drive is caused by the impairment and not the lack of public transportation.
The standard IRS mileage rate will be given for the trip to and from work and also, if needed, the cost to hire a driver.
Hired Transportation - Actual payments made to hire a driver will be allowed but not a mileage allowance.
Exception:
Except for mileage and modifications, costs for the operation of any vehicle are not allowable.
Installation, Maintenance and Repairs - Costs directly associated with these services for all appliances or devices, which qualify as a deduction in this appendix.
Limits on Deductions
Payments for allowable expenses must be made during a month when the individual was working. An individual is considered working even if absent from work temporarily to receive medical treatment.
In addition, a portion of payments for certain items made in any of the eleven (11) months preceding a month of work can be used.
Note: Allowable deductions in anticipation of work are limited to durable items such as medical devices, prosthesis, work related equipment, residential modifications, non-medical appliances and vehicle modifications, as defined in Section A above. Payments for services and expendable items such as drugs, oxygen, diagnostic procedures, medical supplies, and vehicle operating costs are not deductible for purposes of determining payments in anticipation of work.
For recurring expenses, payments made on a regular periodic basis, on credit and paid in installments, or rental, may be used.
For non-recurring expenses the one time payment may be deducted in one month or over a twelve consecutive month period beginning with the month of payment.
For down payments a separate deduction process is possible which may be prorated for up to a year. The proration may be for a shorter time period if the regular monthly payments are extended over a period of less than twelve months. When this happens, the proration time period for the down payment and duration of the regular monthly payments will be the same.
Example:
Individual begins to work on 3/1/07 and at the same time purchases special equipment which costs $4800, giving $1200 down. The balance of $3600, plus interest of $540.00, is to be repaid in thirty-six installments of $115 per month beginning 4/1/07
$ 1200.00 Down payment 3/07
+ $ 1265.00 Monthly payments
$ 2465.00
12 Months
= $ 205.42 Monthly deduction
A monthly deduction of $205.42 would be allowed. Beginning 3/08, the deduction changes to the regular monthly payment of $115.00 per month.
Before any payments are used as deductions against SGA, the amounts must be determined reasonable.
Amounts up to the prevailing charges for durable medical equipment, prosthetic devices, medical services, and similar medically-related items and services as set by Medicare will be allowed. If the individual pays more than the prevailing charge allowed under Medicare it will be allowed if he or she can establish that the average is consistent with normal charges within their community.
Example:
Mr. Adams applies for Medicaid based on his disability. His assets are below $2000. His income consists of Social Security benefits of $132.90 gross and part time earnings of $530.00 gross a month.
After determining that the job was not created out of sympathy, a hobby, or part of therapy or Vocational Rehabilitation training, the presence and value of impairment related work expenses must be considered.
Mr. Adams is currently paying for a special shoe made from a mold and which costs $682.00. He has been making $50.00 payments monthly after an initial $100.00 down payment in 3/08 when he also found employment.
Using the policy under down payments, the calculation for the pretest is:
$ 100.00 Down payment
+ $ 582.00
$ 682.00
12 Months
$ 56.83 Monthly payments over one year
As an allowable Impairment Related-Work Expense:
$ 530.00 Gross wages
- $ 56.83 IRWE
$ 473.17 Compare to earnings allowable standard.
(see example to calculate eligibility).
Appendix C
Pickle Amendment
In order to be considered under this amendment all of the following criteria must be met:
There must have been concurrent entitlement to both SSI or State Supplement and Social Security benefits no earlier than 4/1/77. Concurrent entitlement can occur without concurrent receipt. Usually entitlement to Social Security benefits occurs the month prior to receipt of the first Social Security check.
The individual or couple must be current recipients of Social Security benefits.
The reason for closure of SSI benefits can be for any reason.
If there is a spouse, with Social Security benefits used in the deeming process, the COLA of the spouse may also be disregarded even if the spouse does not qualify for PICKLE status. This disregard applies only when using the SSI income standard as the criteria.
When these conditions are present, all COLA's since the last loss of SSI or the State Supplement (but not prior to 7/77) will be disregarded from monthly countable income as the last step in that process.
Individuals or couples, who are categorically eligible, without using this disregard, are not eligible under the Pickle Amendment.
As an additional benefit, the State of Maine will pay the Medicare Part B premium of Pickle individuals or couples. (see Appendix A)
Once an individual or couple is covered under this group, each additional COLA is disregarded along with the initial increase to determine continued eligibility.
Individuals or couples remain in this group until ineligible due to other SSI criteria, such as no longer living in Maine, increase in assets, increase in income from another source, or change in living arrangements.
Individuals and couples may lose coverage under this group and later regain it. Continuous eligibility is not necessary.
Example:
Mr. Tom Keys' SSI was closed when he became entitled to Social Security benefits in 6/97. A review was completed to determine Medicaid coverage.
$ 600.00 Gross income
- $ 20.00 Federal disregard
$ 580.00
- $ 55.00 State disregard
$ 525.00 > State Supplement standard ($494.00 eff. (1/97)
This determination placed Tom in a deductible for 6/97 – 11/97. In 2/05, Mr. Keys reapplies.
$ 718.20
- $ 20.00 Federal disregard
$ 698.20
- $ 55.00 State disregard
$ 643.20 > State Supplement standard ($589.00)
- $ 118.20 Pickle disregard of COLAs 1/98 - 2005
$ 525.00 < Categorical standard ($589.00)
This results in eligibility effective 2/2005.
One of the problems that may arise during calculation of this disregard results when all the prior Social Security benefits needed are not available through old records of SVES. However, using the following formula, the COLA's can be determined when only one benefit amount is confirmed.
Current Gross Benefit
÷ 1 + COLA increase %
previous gross benefit
Example:
Check received 10/82 shows a benefit amount of $182. The gross would be $12.20 more to account for a deduction for payment of the Medicare Part B premium.
$194.20 Gross amount of check ($182 + $12.20)
÷ 1.074 COLA Percentage Increase for 1982
$180.819 or $181 In 1981 Medicare Part B premium was an even $11.00.
This method is not fault free because the Social Security Administration has changed the rounding off rule several times in recent years. The method will be off if the individual receives benefits based on a spouse or parent's earnings record. Also, if a change in benefit type took place, such as the individual is receiving benefits from a living spouse who dies, changing the claim type to widow benefits.
Appendix D
Other Coverage Groups Still in Federal Law
INDIVIDUALS OR COUPLES WHO WOULD HAVE LOST AID TO THE AGED, BLIND OR DISABLED (AABD) COVERAGE SOLELY DUE TO AN INCREASE IN SOCIAL SECURITY BENEFITS IN AUGUST, 1972
Individuals or couples must have been receiving or eligible to receive AABD in 8/72, and must have received an increase in Social Security Benefits in 8/72. Individuals or couples who would have been eligible for AABD except that they were residing in an institution are also included in this section. If the individual or couple would be eligible for SSI after disregarding the increase in Social Security, the individual or couple is eligible for coverage as Categorically Needy.
INDIVIDUALS WHO WERE ELIGIBLE AS "ESSENTIAL SPOUSES" IN DECEMBER 1973
The individual must have been living with a recipient of the Aid to the Aged, Blind or Disabled (AABD) program in 12/73 and receiving Medicaid at that time. "Essential Spouse's needs must have been used to determine the amount of the AABD grant." In order to continue Medicaid for the "essential spouse,” the former AABD recipient must continue to be eligible for an SSI payment and the needs of the "essential spouse" must continue to be included in determining the payment to the SSI recipient.
INSTITUTIONALIZED INDIVIDUALS WHO WERE ELIGIBLE IN DECEMBER 1973
The individuals must have been eligible for Medicaid in 12/73 as inpatients of medical institutions or intermediate care facilities that were participating in the Medicaid program. The individual must continue to meet Medicaid eligibility requirements in effect in 12/73, continue to reside in the institution and be classified as needing institutionalized care.
BLIND AND DISABLED INDIVIDUALS WHO WERE ELIGIBLE IN DECEMBER 1973
The individuals must meet all current Medicaid eligibility criteria except those for blindness or disability and must have continued to meet all criteria for Medicaid, including blindness and disability, in effect in 12/73.
Appendix E
Life Estate and Remainder Interest Tables
Age | Life Estate | Remainder | Age | Life Estate | Remainder 0 | 0.97188 | 0.02812 | 53 | 0.82028 | 0.17972 1 | 0.98988 | 0.01012 | 54 | 0.81054 | 0.18946 2 | 0.99017 | 0.00983 | 55 | 0.80046 | 0.19954 3 | 0.99008 | 0.00992 | 56 | 0.79006 | 0.20994 4 | 0.98981 | 0.01019 | 57 | 0.77931 | 0.22069 5 | 0.98938 | 0.01062 | 58 | 0.76822 | 0.23178 6 | 0.98884 | 0.01116 | 59 | 0.75675 | 0.24325 7 | 0.98882 | 0.01118 | 60 | 0.74491 | 0.25509 8 | 0.98748 | 0.01252 | 61 | 0.73267 | 0.26733 9 | 0.98663 | 0.01337 | 62 | 0.72002 | 0.27998 10 | 0.98565 | 0.01435 | 63 | 0.70696 | 0.29304 11 | 0.98453 | 0.01547 | 64 | 0.69352 | 0.30648 12 | 0.98329 | 0.01671 | 65 | 0.67970 | 0.32030 13 | 0.98198 | 0.01802 | 66 | 0.66551 | 0.33449 14 | 0.98066 | 0.01934 | 67 | 0.65098 | 0.34902 15 | 0.97937 | 0.02063 | 68 | 0.63610 | 0.36390 16 | 0.97815 | 0.02185 | 69 | 0.62086 | 0.37914 17 | 0.97700 | 0.02300 | 70 | 0.60522 | 0.39478 18 | 0.97590 | 0.02410 | 71 | 0.58914 | 0.41086 19 | 0.97480 | 0.02520 | 72 | 0.57261 | 0.42739 20 | 0.97365 | 0.02635 | 73 | 0.55571 | 0.44429 21 | 0.97245 | 0.02755 | 74 | 0.53862 | 0.46138 22 | 0.97120 | 0.02880 | 75 | 0.52149 | 0.47851 23 | 0.96986 | 0.03014 | 76 | 0.50441 | 0.49559 24 | 0.96841 | 0.03159 | 77 | 0.48742 | 0.51258 25 | 0.96678 | 0.03322 | 78 | 0.47049 | 0.52951 26 | 0.96495 | 0.03505 | 79 | 0.45357 | 0.54643 27 | 0.96290 | 0.03710 | 80 | 0.43659 | 0.56341 28 | 0.96062 | 0.03938 | 81 | 0.41967 | 0.58033 29 | 0.95813 | 0.04187 | 82 | 0.40295 | 0.59705 30 | 0.95543 | 0.04457 | 83 | 0.38642 | 0.61358 31 | 0.95254 | 0.04746 | 84 | 0.36998 | 0.63002 32 | 0.94942 | 0.05058 | 85 | 0.35359 | 0.64641 33 | 0.94608 | 0.05392 | 86 | 0.33764 | 0.66236 34 | 0.94250 | 0.05750 | 87 | 0.32262 | 0.67738 35 | 0.93868 | 0.06132 | 88 | 0.30859 | 0.69141 36 | 0.93460 | 0.06540 | 89 | 0.29526 | 0.70474 37 | 0.93026 | 0.06974 | 90 | 0.28221 | 0.71779 38 | 0.92567 | 0.07433 | 91 | 0.26955 | 0.73045 39 | 0.92083 | 0.07917 | 92 | 0.25771 | 0.74229 40 | 0.91571 | 0.08429 | 93 | 0.24692 | 0.75308 41 | 0.91030 | 0.08970 | 94 | 0.23728 | 0.76272 42 | 0.90457 | 0.09543 | 95 | 0.22887 | 0.77113 43 | 0.89855 | 0.10145 | 96 | 0.22181 | 0.77819 44 | 0.89221 | 0.10779 | 97 | 0.21550 | 0.78450 45 | 0.88558 | 0.11442 | 98 | 0.21000 | 0.79000 46 | 0.87863 | 0.12137 | 99 | 0.20486 | 0.79514 47 | 0.87137 | 0.12863 | 100 | 0.19975 | 0.80025 48 | 0.86374 | 0.13626 | 101 | 0.19532 | 0.80468 49 | 0.85578 | 0.14422 | 102 | 0.19054 | 0.80946 50 | 0.84743 | 0.15257 | 103 | 0.18437 | 0.81563 51 | 0.83674 | 0.16326 | 104 | 0.17856 | 0.82144 52 | 0.82969 | 0.17031 | 105 | 0.16962 | 0.83038
STATE OF MAINE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
To: Case No:
CONSENT DECISION
On or about a hearing was requested on behalf of (applicant) _____ to appeal the allocation of spousal assets.
Both (applicant & spouse) and the Department agree to the following:
(applicant) resides in a nursing facility and applied for Medicaid on ___________. (applicant's spouse) is the community spouse.
As indicated below, (applicant’s spouse) can keep $__________ of the couple’s countable assets effective ___________.
INCOME ALLOWANCE
$ ____________ Monthly mortgage/rent
+ ____________ Real estate taxes
+ ____________ Condo fees
+ ____________ Home owners insurance
+ ____________ Utility standard
$ ____________ Total shelter expenses
- ______ 582.00 (30% of Chart 4.4)
$ ____________ Excess Shelter Expense
+ _____1,939.00 Minimum Monthly Income Standard (Chart 4.4)
$ ____________ May not exceed Monthly Income Allowance (Chart 4.4)
- ____________ Community spouse's gross income
- ____________ Community spouse monthly income allocation
= ____________ Deficit in meeting Monthly Income Allowance
Average cost of an annuity to generate $__________ per month income is $__________.
Dated Signed ( Supervisor)
for the Department of Health and Human Services
Dated Signed
Institutionalized spouse or representative
Based upon the agreement between the parties, this CONSENT DECISION to the hearing requested in this matter is the final agency action on the appeal.
Dated Signed
Hearing Officer
Appendix G
Supplies Provided to Recipients in a Nursing Facility
Below is a list of Supplies and Equipment provided to recipients by a Nursing Facility as part of regular rate of reimbursement:
The following items may not be billed by either the facility or supplier. Facilities which service a special group of the disabled are expected to furnish that equipment which is normally used in their care (e.g. children's wheelchairs) as a part of their reasonable cost.
Routine supplies and personal care items which are provided by the Nursing Facility under 67.05-11(A), may not be purchased by a resident and then deducted from their cost of care. The Nursing Facility must provide any brand name item to the resident as part of the Nursing Facility regular rate of reimbursement if the resident has a therapeutic need as documented by the physician.
Alcohol, swabs and rubbing
Analgesics: (non-prescription): 1) Acetaminophen: tablets, 325 mg, 500 mg; liquid; suppositories, 325 mg, 650 mg. 2) Aspirin: tablets, 325 mg, plain, buffered, coated; suppositories, 325 mg, 650 mg.
Antacids: aluminum hydroxide, magnesium hydroxide: gel and tablets (ex. Maalox). 2) Aluminum/magnesium hydroxide with simethicone (ex. Mylanta, Maalox Plus). 3) Calcium carbonate tablets (ex. Tums). 4) Calcium carbonate/magnesium hydroxide tablets (ex. Rolaids).
Alternating pressure pads, air mattresses, "Egg crate" mattresses, gel mattresses
Applicators
Bandages
Band-Aids
Basins
Beds (standard hospital type, not therapy beds)
Bed pans
Bed rails
Blood pressure equipment
Bottles (water)
Canes
Calcium supplements: 1) Calcium carbonate (ex. Tums). 2) Calcium carbonate with vitamin D (ex. Oscal).
Catheters
Catheter trays (disposable)
Chairs (standard, geriatric)
Combs
Commodes
Corner chair
Cotton
Cough syrup & expectorants: (non prescription) 1)Guaifenesin (ex. Robitussin). 2)Guaifenesin - DM (ex. Robitussin DM) 3) Ammonium chloride/diphenhydramine (ex. Benylin).
Crutches
Cushions (e.g., comfort rings)
Dietary supplements
Disinfectants
Douche trays (disposable)
Dressings
Enema equipment
Enteral feedings, supplies and equipment
Facility deodorants
Gauze bandages (sterile & unsterile)
Glucometers
General services such as administration of oxygen and related medications, hand feeding, incontinency care, tray service and enemas
Gloves (sterile)
Gloves (unsterile)
Gowns
Hemorrhoidal preparations
Ice bags
Incontinent supplies full brief - all sizes; bed pans; undergarment liners, disposable or reusable; under pads.
Iron supplements (oral: ferrous sulfate; ferrous gluconate; liquid and/or tablet
Irrigation trays
Laundry services, personal (including supplies and equipment)
Laxatives: Stool softeners: docusate sodium liquid or capsule. Bulk: psyllium. Stimulants: Bisacodyl tablets and suppositories; docusate casanthranol, liquid and/or capsule. Enemas: saline; phosphate types (ex. Fleets); oil retention. Misc.: Milk of Magnesia; glycerin suppositories; lactulose and analogs (when used as a laxative); mineral oil.
Lotions (emollient) and Lubricants (skin, bath oil)
Mouth wash
Ointments and creams ( over the counter), including petroleum jelly and hydrocortisone 0.5%
Ophthalmic lubricants: tears, ointments
Oxygen, for emergency and prn use only
Parenteral solutions, supplies and equipment
Pillows
Pitchers (water)
Powders (medicated and baby)
Prone boards
Rectal medicated wipes
Restraints (posey, thoracic chest supports, tilt in space chairs, wedge pillows, etc.)
Shampoo: three types: 1) regular; 2) medicated; and 3) no tears - baby shampoo
Sheepskin
Shower chairs/ Tub seats
Soap: include one hypoallergenic type
Special dietary supplements
Specimen containers
Sterile I.V. or irrigation solution
Stethoscope
Sunscreen - level 30
Supplies (non-prescription) necessary for the treatment of decubiti
Suture sets
Swabs, medicated or unmedicated
Syringes and needles
Tapes
Testing materials to be used by staff or facility
Thermometers
Tissues
Toothbrush
Toothpaste - two types accepted by AFA; and a denture cleaner
Towels, washcloths
Tongue depressors
Traction equipment
Trapezes
Tubes (gavage, lavage, etc.)
Urinals
Urinary drainage equipment and supplies (disposable)
Vitamins: two brands acceptable to pharmacy and dietary
Walkers
Wheelchairs - standard, including those with removable arms and leg rests, pediatric, "hemi" chairs, reclining wheelchairs
Routine personal hygiene and grooming to include, but not limited to: shave, shampoo, bathing, nail clipping (unless specified as a covered service by a podiatrist in the MaineCare Benefits Manual), unless the services of a barber or hairdresser are requested by and paid for by the resident
Routine transportation of residents or laboratory specimens to hospital or doctors offices
Appendix H
Transfers Prior to January 1, 1994 and Trusts Prior to August 11, 1993
These rules apply to trusts that are set up prior to 8/11/93.
TRUSTS
Trust funds are available assets unless the terms of the trust make them unavailable.
If the trust is irrevocable, that is, no member of the assistance unit or any responsible relative residing in the home has the power to revoke the trust arrangement or change the name of the beneficiary, what is available to the client is what is made available according to the terms of the trust.
The terms of the trust may specify the amount/frequency and/or purposes for which the funds may be used or this may be left to the discretion of the trustee(s). The terms of the trust may use a combination of both trustee discretion and specific fund usage.
Of the funds left to trustee discretion, what is available to the client is whatever the trustee makes available.
Funds made available are considered as income or assets in accordance with applicable Medicaid eligibility rules for the situation.
If the terms of the trust restrict withdrawal by written approval of a judge of the courts, regular withdrawals will be treated as any other income. Irregular withdrawals, in order to be disregarded, must be used to supplement the needs of the person for whom the trust is drawn up.
Examples
An individual has a trust fund that was established upon the death of his parents based on their will. From this he is to receive $500 from the interest each month and $10,000 every three years to buy a new vehicle. The monthly payments are income. The $10,000 is used to purchase an excluded asset (the old vehicle is traded in to purchase the new one). This trust is irrevocable in accordance with the provisions above. The terms of the trust specify the amount, frequency and for part of the payments (the $10,000) the purpose. Medicaid policy treats interest payments as income and excludes the vehicle as an asset.
A trust was set up for the individual by his father who is deceased. The individual is to receive $200 per month for as long as the fund lasts. The fund currently has $140,000. The individual can get all the funds in the trust if there is an emergency. The $200 per month is considered income as long as this represents interest income. The remainder of the fund is considered an asset (currently $140,000) since it can be accessed by the individual.
A trust is set up for the individual by her grandmother. It is irrevocable and the trustee has full discretion in disbursement of the funds (totaling $75,000) based on the needs of the individual. Since the trust is irrevocable, what is considered available to the individual is whatever the trustee, in her discretion, makes available.
Medicaid Qualifying Trusts
Even if a trust is irrevocable, it may be considered as an available asset if it meets certain conditions listed below. These are called Medicaid Qualifying Trusts. This is a type of trust or other legal device which:
is established by the individual or individual's spouse (other than by will). It may be irrevocable or established for purposes other than to enable the grantor to qualify for Medicaid;
the individual is the beneficiary of all or part of the payments from the trust;
the distribution of such payments is determined by one or more trustees who are permitted to exercise discretion with respect to the distribution to the applicant; or
when established by the individual's or spouse's legal guardian or power of attorney, the trust is considered to have been established by the individual or spouse whom they represent.
The amount of this trust that is counted as an asset is the total undistributed amount that is permitted under the terms of the trust that the trustee could disburse if he, as trustee, exercised his full discretion.
Because Medicaid is the payer of last resort, it is expected that individuals (and their spouses) access available trust income and assets before turning to Medicaid. The assets and income from trusts that contain provisions that purport to limit the trustee's discretion to disburse funds in situations related to the individual's application for Medicaid are to be considered without regard to such provisions. For example, the assets and income of a trust are to be considered without regard to any provisions that purport to limit the trustee's discretion to disburse funds when the individual applies for Medicaid or enters a nursing home.
Example
Mary establishes a trust under which she is a beneficiary. The trustee has discretion to distribute all of the assets of the trust to Mary except if she applies for Medicaid or enters a nursing home. In those circumstances, the trust states that the trustee does not have discretion to disburse the funds to Mary. At the time Mary applies for Medicaid, the trust is valued at $200,000. All of the $200,000 is considered available to Mary.
Amounts actually distributed are counted as income and/or assets using applicable eligibility rules for the situation.
When determining eligibility for Nursing care assistance, the value of an irrevocable trust may constitute an uncompensated transfer of assets. See Part 15.
If the Department determines that denial of eligibility would constitute undue hardship, these provisions may be waived. The consequence of being denied Medicaid coverage by itself does not constitute undue hardship.
Exceptions
When the beneficiary of a trust is a mentally retarded individual who resides in an Intermediate Care Facility MR the trust is not considered a Medicaid qualifying trust provided the trust or initial decree was established prior to 4/7/86 and is solely for the benefit of the mentally retarded individual.
Trusts that are set up with retroactive SSI benefits awarded under the Zebley vs. Sullivan decision are exempted from the provisions of the Medicaid Qualifying Trust and transfer of assets rules.
Examples
The individual's wife set up a trust fund for him before she died. The trust is irrevocable. The individual receives monthly payments of $100.00 from interest accrued on the principal and the trustee may disburse the remaining funds (currently $150,000) to meet living expenses. This is a Medicaid Qualifying Trust because it was set up by the individual's wife (not by will). Therefore, the total amount of the trust ($150,000) is a countable asset. This is the total undistributed amount of the trust that the trustee could disburse if she exercised her full discretion.
Same as Example 1 except: Added to the monthly interest income of $100.00, the remaining funds are disbursed in $3,000 semi-annual payments for the life of the individual. Any funds remaining at his death are passed to the individual's daughter. The trustee has no discretion in the disbursement of funds. Here, both the $100.00 per month and the $3,000 semi-annual payment are income. Since the trustee has no discretion in disbursement of funds, nothing else is countable.
The individual sets up a trust fund for himself that is irrevocable. He receives $500.00 per month from interest. The principal will be donated to the Save the Whale Foundation at his death. The trustee has no discretion in disbursement of funds. This is not a Medicaid Qualifying Trust even though it was set up by the individual other than by will for his benefit because the trustee has no discretion in distribution of the trust funds. The disbursement of $500.00 per month are counted as income under the general rules applying to trusts.
Couples Residing in a Nursing Facility
If the total assets of a couple in the same room in a nursing facility exceed the standard for a couple, one of the individuals may reapply for assistance. This results in one being an ineligible spouse. Beginning the first of the month after being denied, only the assets remaining in the name of the eligible spouse are considered when determining eligibility.
If the couple resides in different rooms in the same facility or in different facilities, then each is treated as an individual when determining the asset limit. Since there is no penalty for transfer of assets between spouses, they can decide who will retain the assets.
No spousal allowance of income or assets is determined since the ineligible spouse is not living in the community.
Transfer of Assets
"Assets" are defined as cash or other liquid assets or real or personal property.
When determining eligibility for BME, BMR and ALPHA Waivers and nursing care services, the following applies to transfers to individuals by the applicant or the applicant’s spouse. Transfers between spouses do not incur a penalty. Although an individual or couple may be eligible in the community, once a request is made for waiver or nursing care services all assets must be checked back thirty months from date of application to determine if a transfer has occurred.
Transfers only affect nursing and waiver services, all other Medicaid services may still be covered.
To determine the effect that the transfer has on eligibility several questions must be answered:
What was transferred?
Who was the transfer made to?
When was the transfer made?
What did the individual or couple receive in exchange?
Why was the transfer made?
Exempt Transfers
The following may be transferred without penalty:
The home if it is transferred to
a child who is under age 21 or who does or would meet SSI criteria of total and permanent disability or blindness.
a sibling who has an equity interest in the home and was residing in the home for at least one year prior to the individual going to the medical institution.
Example
A brother and sister have joint ownership of a home in which they both lived for the last five years prior to the brother going into a nursing facility. The brother may transfer his interest in the home to his sister without penalty.
A penalty would be established if:
the sister was not a joint owner or had no equity interest in the home, or
the sister had not lived in the home one year prior to the institutionalization of her brother.
a child over age 21 who does not meet the SSI criteria of blindness or disability if the child was residing in the home for at least two years prior to the individual's entering the medical institution and was providing care which enabled the institutionalized individual to live at home rather than a medical institution for this time.
a spouse.
Any asset transferred to the individual's child who does or would meet SSI criteria of total and permanent disability or blindness.
Assets which the owner intended to dispose of at fair market value or for other valuable consideration but, without being at fault, the owner did not obtain full fair market value.
Assets, exempt or non-exempt, transferred to (or for the sole benefit of) the community spouse.
Assets transferred thirty months prior to the date of application.
Assets transferred for Fair Market value:
Fair Market Value
A transfer for fair market value incurs no penalty. Fair market value may be received in cash. It may also be in the form of past support for basic necessities or past medical expenses and debts, if measurable and verifiable. A reasonable value must be placed on the support provided or medical costs and the specific time period for which it is given substantiated. Past support for basic necessities does not include such items as gifts, clothing, transportation or personal care provided by relatives unless these were provided as part of a legally enforceable agreement whereby the individual would transfer the asset or otherwise pay for such items.
Examples of transfer for fair market value
An individual transfers ownership of a life insurance policy to a funeral home.
An individual's sister pays all household expenses while he waits for an insurance settlement of $5000. He verifies that his rent, utilities and food came to $4500. He may transfer the $4500 to his sister without penalty because these are basic necessities which are measurable and verifiable.
Examples of transfers for less than fair market value
A couple sells their home to their son for $40,000. The assessed value is $70,000. A $30,000 transfer has occurred.
An individual has help from her daughter with shopping, cleaning and preparing meals. The daughter spends four to eight hours a week providing these services. When the individual enters a nursing facility she transfers $25,000 to her daughter to compensate for these services. Since these were not provided as part of a legally enforceable agreement to pay for these services, the transfer does result in a penalty.
A neighbor comes in for an hour a day to help a couple prepare meals and do laundry. Two years later the couple give the neighbor $50,000. Two months later they enter a nursing facility. Based on the average cost for homemaker services in the area a value of $10.00 per hour is placed on these services and $7280 of the transfer is allowed. The remaining $42,720 would be a transfer for less than fair market value.
Disproving the Presumed Transfer
Any transfer taking place will be presumed to have been made for the purpose of becoming or remaining eligible for Medicaid, unless the individual furnishes clear and convincing evidence that the transaction was for some other purpose and that there was no intent at the time to apply for Medicaid within the foreseeable future. It is the Department's responsibility to demonstrate that a transfer took place and to establish the date of the transfer. It is the individual's responsibility to prove that the transfer took place for reasons other than to gain eligibility for Medicaid.
If the individual wants to disprove the presumption that the transfer was made to establish Medicaid eligibility, the burden of proof rests with the individual. The individual must demonstrate that the transfer was specifically and solely for some other purpose than to receive Medicaid. Statements and evidence to disprove the transfer must be contained in the individual's record.
The statement should cover, but not necessarily be limited to the individual's:
purpose for transferring the asset;
attempts to dispose of the asset for fair market value;
reasons for accepting less than the fair market value for the asset;
plans for and ability to provide financial support after the transfer;
relationship, if any, to the persons to whom the asset was transferred; and
belief that the fair market value was received.
In addition to the individual having to prove that the transfer was made specifically and solely for a purpose other than to be Medicaid eligible, other factors to be considered include:
a sudden onset of a disability or blindness after the asset was transferred;
the diagnosis of a previously undetected disabling condition after the transfer occurred;
unexpected loss of other assets following the transfer;
unexpected loss of income after the transfer occurs; and
court ordered transfers.
Establishing Date and Value of a Transfer
Assets other than bank accounts. A transfer of assets occurs on the date when:
title (ownership) or legal interest to property has passed from the individual or spouse to another individual;
title to property has been given by establishing joint ownership, such as adding a name to stocks, bonds, real property;
The value of the transfer is the value of the asset or the part of the asset that is transferred. For example:
Sole ownership of a home valued at $100,000 is transferred to another. The value of the transfer is $100,000.
Sole ownership of a home valued at $100,000 becomes jointly owned with another person. The value of the transfer is $50,000.
a document has been signed and delivered by the individual or spouse to another individual to transfer title at some future date. This concept does not include a will but does include a signed but unregistered deed;
the asset is converted from an accessible to an inaccessible asset. An example is when assets are placed in an irrevocable trust or a name is removed from a jointly owned asset; or
the individual or spouse refuses to accept items which would be countable assets.
With bank accounts, a transfer of funds in an account is determined to take place when:
funds, owned by the individual, are withdrawn by the other joint owner(s) from an account and used for other that the sole benefit of the individual; or
another person's name is added to the individual's account, the money in the account is owned by the individual, and the intent of the individual in giving access is to convey ownership of those funds.
If the individual maintains that there was an intent to transfer funds in the bank account at the time a joint name was added, this intent must be documented.
Documentation consists of a clearly written statement of intent to transfer the funds in the account to the joint owner. This statement must be:
a notarized statement; or
signed by the individual at the time the account was made joint or within a reasonable period of time, usually one week but maybe longer due to circumstances beyond the control of the client.
Note: Evidence of an intent to transfer the funds in the account at the time that the name was added to the account will be rebutted by evidence that the individual continued to use the funds.
Examples
George adds his son Larry's name to a $50,000 bank account in 8/91. In 6/92 Larry withdraws $50,000 which he used to make renovations on his (Larry's) home. George is applying for nursing care services 9/92.
Whose money is the $50,000? The money in the account is made up of deposits by George. This is George's money and there is a potential transfer.
What was George's intent of adding son's name? If the intent was to convey ownership of the funds in the account, this must be documented with a notarized statement by George. In this situation, there is no statement from George. No transfer occurred when Larry's name was added as a joint owner.
The 6/92 withdrawal is then examined as a transfer. Since Larry used the $50,000 that was withdrawn for other than the sole benefit of George, a transfer has occurred. Unless the transfer is exempted (4120.01), the penalty is assessed for $50,000 as of 6/92.
Sally adds her son's name (Sam) to her bank account in 12/88. At that time there was $70,000 in her account. At the time of adding her son's name to the account she signs a statement that she intends to transfer the funds in the account. Subsequently, Sally cashes a check for $10,000 from the account. Also during the transfer penalty period, Sam cashes a check for $20,000 from the joint account. At the time Sally applies for nursing care services in 9/92, there is $40,000 in the account.
The $20,000 spent by Sam was a transfer subject to penalty. This is because Sally's continued use of the funds in the account rebuts her written statement saying she intended to transfer the funds to her son at the earlier time. Since the funds were Sally's when Sam cashed the check for $20,000, this is a transfer subject to penalty.
The $40,000 remaining in the account is considered an available asset for Sally.
Butch adds his nephew's name (Charles), to his (Butch's) solely owned bank account in 1/89. The $70,000 in the account was owned by Butch. There is documentation that Butch intended to transfer the funds in the account at that time. In 5/92, Butch sells a piece of his solely owned property for $20,000 and deposits this money in the joint account. Charles cashes a $20,000 check from the account in 6/92. The account totals $70,000 at the time Butch applies for nursing care services in 9/92.
The $20,000 withdrawn by Charles in 6/92 is considered to be part of the $70,000 that Butch intended to give his nephew in 1/89. Therefore, this $20,000 may not be subject to transfer penalty.
Of the remaining $70,000 in the account:
$20,000 is a countable asset for Butch since this $20,000 was deposited by him from his funds.
$50,000 is owned by Charles due to the 1/89 transfer of funds.
Establishing a Penalty
A period of ineligibility is imposed on the individual in a nursing care status if the individual or spouse disposes of an asset for less than Fair Market Value.
When a penalty is imposed, it is only the nursing care services that cannot be paid. The individual may be eligible for all other Medicaid services.
Once it has been determined that a transfer of assets has occurred for less than fair market value, the penalty period must be determined.
A special determination must be made for each transfer.
Determine the date that each transfer occurred.
Determine the amount of the transfer.
Divide the amount of the initial transfer by the current average monthly private rate at the time of application for a semiprivate room rate for a nursing facility (see Chart 4.3).
This determines the number of months of ineligibility based on the initial transfer. Any remaining fraction is to be disregarded. The penalty period may not exceed thirty months. The penalty period begins with the month in which the uncompensated transfer occurred. If there had been more than one transfer and a penalty is already in effect for that month, the penalty period will begin with the next non-penalty month.
Examples
An individual adds her daughter's name to her savings account on 4/14. A transfer for the entire balance has taken place. Based on the amount of funds in the account at the time of transfer she is ineligible for 7.3 months. Eligibility potentially begins 11/1.
An individual has a solely owned savings account with $60,000 in it. In 10/92 he transfers $60,000 to his daughter. He also owns stocks worth $40,000 which he transfers to his son in 12/92.
10/92 $60,000 $3619 = 16.5 months, potentially eligible 2/94
12/92 $40,000 $3619 = 11 months, potentially eligible 1/95
The penalty on the 12/92 transfer does not start until 2/94. This is the first non-penalty month after the 12/92 transfer
In this case the individual is potentially eligible as of 1/95.
Appendix I
Preparation for and Participation in the Administrative Hearing Process
The purpose of a hearing is to review whether the Agency acted in accord with defined policy and procedural requirements in carrying out its actions. The review is usually requested in relation to proposed closings, denials, decreases in the level of coverage, and changes in deductible amounts. The hearing may also include questions of medical eligibility, classification for nursing care status and eligibility for retroactive coverage.
Hearings are not formal in the sense that there are oaths given, set formal procedures of addressing individuals concerned, or required procedures for entering objections or questioning at a particular time. Hearings are not casual conversations or arguments, however.
In addition to reviewing the decision itself, the Hearing Officer has the responsibility, at the hearing, to review whether appropriate procedures were followed in carrying out the action.
The Hearing Report
The agency representative has the responsibility to be prepared to give a report and to answer questions that may be asked by the Hearing Officer of other participants in the hearing. The Eligibility Specialist must make sure that proper written notice, with an advance notice period, if applicable, was forwarded to the applicant or recipient. The notice must cite the manual section on which the decision to deny or reduce benefits is based. It is not sufficient to state: “You have excess assets,” or “You have excess income.” The amount of assets or income should be given. In addition, the agency limit on assets or income should be cited. It might be necessary to cite more than one manual reference. If so, this should be done.
If the action results in a request for a hearing the Eligibility Specialist should submit a copy of the notice which was sent to the applicant or recipient to the Hearing Officer. The copy of the notice and other pertinent documents will become a permanent part of the Hearing Record.
When notified of a request for a hearing, the Eligibility Specialist must prepare a detailed report outlining what was done and why it was done. The report should indicate how the decision was made. If income is an issue, the Eligibility Specialist must elaborate on how net income was determined. If assets are an issue, the Eligibility Specialist must show what was considered as an asset. If medical eligibility is an issue, specifics should be given as to what went into the decision that the individual no longer is considered incapacitated or disabled in accord with agency policy. If the decision involved the Medical Review Team, contact must be made with that unit, The MRT will provide medical information if necessary.
If negative action is taken because information is incomplete, inconclusive or conflicting, the Eligibility Specialist must show what is inconclusive and why more information is needed. The Eligibility Specialist also has responsibility to show that specific information was requested and that the individual was given the opportunity to resolve questions before action was taken.
A copy of the report is sent to the individual requesting the hearing by the Division of Administrative Hearings prior to the hearing. If the agency is informed that the individual has a representative for the hearing, a copy of the report is also sent to the representative.
To the extent that the report is complete and concise, it will assist the Hearing Officer in conducting the hearing and will assist the applicant or recipient in understanding or questioning information.
The Hearing - The Hearing Officer will begin the hearing by giving an opening statement. In the opening statement, the Hearing Officer will:
cite the case name and basis purpose of the hearing;
request the names of all present;
remind all persons that the hearing is being recorded and that individuals should follow procedures by:
identifying themselves and referring to each other by name during the hearing;
make an effort to speak loud enough to be heard by all participants and face the recording equipment while talking.
Note that exhibits will be presented during the hearing.
After an opening statement by the Hearing Officer, the Eligibility Specialist will be asked to present a copy of the notice which was sent to the applicant or recipient.
The Hearing Officer will request a verbal report outlining the actions taken and the basis of the action. The report submitted by the Eligibility Specialist may be read or used as the basis for the verbal report. The Hearing Officer may ask additional questions if there areas which are unclear. In addition, copies of documents such as medical statements, budgets, lists of assets or medical bills may be requested by the Hearing Officer. When requested, copies of these items should be given to the Hearing Officer and the individual requesting the hearing.
The individual or the representative may question the decision of the Eligibility Specialist. Questions should be made through the Hearing Officer and not between the persons involved.
The individual requesting the hearing will be given the opportunity to:
question any information;
refute any information;
present any additional information or make any comments.
In situations where additional information is presented, the Hearing Officer will decide whether the information had a bearing on the decision in question at the time of the decision or whether the information relates to a period of time subsequent to the decision. If the latter is the situation, the information should only be considered in a re-application or in carrying out a subsequent review.
After both parties have presented information and entered any questions and the Hearing Officer is satisfied that pertinent data has been presented, the Officer will summarize the issue as much as possible.
A continuance of the hearing may be determined by the Hearing Officer if additional date is needed, obtainable, and not available at the hearing. If the applicant or recipient requests a continuance, the Hearing Officer will determine if it would be appropriate.
The agency representative should always have manual material at the hearing and be prepared to cite necessary data from the manual.
Appeal
When the above procedures are followed and there is further appeal through the courts, those persons responsible for representing the agency have issues that are clearly defined. In addition, procedures such as adequate and specific notice may be raised in court even if not mentioned at a hearing. Thus, it is necessary that procedures taken, as well as the decision made, be reviewed at the hearing.
Appendix J
Computation of Utility Standard
Standard Utility Allowances are approved through the Food and Nutrition Service of the United States Department of Agriculture and are included in the rules for Maine’s Food Supplement Program at 10-144 CMR Chapter 301. Standard Utility Allowance values can also be found at www.maine.gov/dhhs/ofi/fs-standards.shtml or by consulting www.fns.usda.gov/snap and search for Standard Utility Allowance Charts for the current values.
Utility Expenses
The community spouse has the option of using the full standard utility allowance (FSUA or actual utility expenses as deductions. They must incur expenses for heating or air conditioning bills which are separate and apart from rent/mortgage or receive assistance from HEAP or ECIP in order to qualify for the FSUA. At the time of redetermination, and one additional time during each twelve month period, the community spouse may change the option between actual expenses and the FSUA.
Standard Utility Allowance
When expenses are incurred on an irregular basis, use the FSUA between billing periods. The FSUA cannot be used for a community spouse who lives in a public or private rental unit, which has central utility meters and charges the residents only for excess heating or air conditioning costs. If someone outside of the household is paying the entire cost of heating/cooling, and the payment is excluded as a vendor payment, the utility allowance is not allowed.
Note: Assistance from HEAP or ECIP automatically entitles the community spouse to the FSUA.
The FSUA is not allowed when utility expenses are included in the rent unless the community spouse receives assistance from HEAP or ECIP, the residence is metered separately, or the community spouse can otherwise provide verification that there are separate charges for heat and/or air conditioning.
Actual Utility Costs
If the community spouse resides in public housing, which has central utility meters and is charged only for excess utility costs, the excess amount incurred is allowed.
Whenever the FSUA is not permitted, the community spouse may claim the actual expenses or elect to use the individual standard:
Shared Residence
To determine the utility allowance when the residence is shared by the community spouse and other persons, divide the appropriate utility allowance equally among the parties who pay for the cost. This prorated share is the utility allowance.
Home Temporarily Vacated
Shelter expenses can be allowed if the principle residence is temporarily vacated due to employment or training, illness, natural disaster or casualty loss only if:
the community spouse intends to return
the home is not leased or rented while the community spouse is absent.
Note: Verification of actual utility cost for an unoccupied home is required if a deduction will be used. The SUA is not allowed for unoccupied homes.
Handling of Expenses Other Than Mortgage, Residence Insurance
Except when an expense is averaged, a deduction is allowed only in the month the expense is billed or otherwise becomes due, regardless when the community spouse expects to pay the expense. Amounts from past billing periods are not deductible.
For an expense to be deductible, it must be payable to someone outside the household.
Fluctuating expenses may be averaged. Expenses, which are billed less often then monthly, may be averaged forward over the interval between scheduled billings or if there is no schedule, over the period the expense is intended to cover. Interest, carrying charges, insurance, or penalties are not allowance expenses. Interest portions on mortgage payments are allowable.
That portion of the household shelter expenses associated with a business or trade is not considered as a deductible shelter expense.
That portion of the shelter expenses paid by an excluded vendor payment shall not be allowed as a deduction. Shelter expenses paid via a countable vendor payment shall be allowed.
Shelter expenses shall be computed based upon expected expenses to be billed. Anticipation of the expense shall be based upon the most recent month's bills unless it is reasonably certain that a change will occur.
Expenses billed weekly are converted by multiplying by 4.333 and those billed biweekly by 2.167 to obtain monthly figures.
III. Verification
Utility expenses must be verified if the amounts claimed are in excess of the SUA and a deduction would result.
A move to a new residence requires reassessment of all shelter expenses.
Chart 1
ITEMS INCLUDED IN THE BASIC COST CHART
Housing: includes either a payment for rent or home ownership costs (which include taxes, mortgage payments, insurance and property maintenance), heating fuel, water, electricity, gas, refuse disposal, household textiles such as sheets and towels, furniture and appliance replacement, house wares, laundry and cleaning supplies, paper products, services and telephone at the basic rate.
Food: includes all food eaten at home, meals eaten at work or school and snacks.
Clothing: includes basic inner and outer clothing, undergarments, footwear, dress and work clothing, cleaning and pressing services and shoe repair.
Personal Care: includes haircuts, hair dressing, and such items as toothpaste, shaving cream, and shampoo.
Other Family Consumption: includes newspapers, magazines, entertainment expenses and allowances for participation in sports, hobbies and other recreation.
Chart 2
DEPENDENT ALLOCATIONS USING AFDC RELATED LIMITS
The amounts below are used for income allocations for dependents in Home and Community Based Waivers and dependents of nursing home residents when there is no community spouse. They are based on the Full Need Standard in the AFDC Program as of 8/96.
ADULTS INCLUDED | ADULTS NOT INCLUDED Unit Size | Full Need | Full Need 1 | 262 | 154 2 | 412 | 295 3 | 553 | 437 4 | 695 | 579 5 | 837 | 721 6 | 979 | 863 7 | 1120 | 1005 8 | 1262 | 1146
Add $142 to Full Need for each additional person.
Chart 3
SSI - RELATED INCOME STANDARDS, ALLOCATIONS AND DISREGARDS
Chart 3.1 - Disregards (eff. 7/1/87)
$20.00 Federal disregard
$55.00 State disregard for Individual
$80.00 State disregard for Couple
Chart 3.2 - Maximum Allocations
Ineligible child living allowance Maximum Federal Supplemental Security Income (SSI) payment amount for an eligible individual, divided by 2.
One parent - living in the household Maximum Federal Supplemental Security Income (SSI) payment amount for an eligible individual.
Two parents living in the household Maximum Federal Supplemental Security Income (SSI) payment amount for an eligible couple.
Chart 3.3 - Maximum Income-in-Kind
Individual living alone or with others Maximum Federal Supplemental Security Income (SSI) payment amount for an eligible individual, divided by 3, plus $20.
Individual living in the household of another Maximum Federal Supplemental Security Income (SSI) payment amount for an eligible individual, divided by 3.
Couple Living alone or with others Maximum Federal Supplemental Security Income (SSI) payment amount for an eligible couple, divided by 3, plus $20.
Couple living in the household of another Maximum Federal Supplemental Security Income (SSI) payment amount for an eligible couple, divided by 3.
Chart 3.4 - Maximum Countable Income
Individual living alone or with others Maximum Federal Supplemental Security Income (SSI) payment amount for an eligible individual, plus $10.
Individual living in the household of another Maximum Federal Supplemental Security Income (SSI) payment amount for an eligible individual, plus $8.
Couple living alone or with others Maximum Federal Supplemental Security Income (SSI) payment amount for an eligible couple, plus $15.
Couple living in the household of another Maximum Federal Supplemental Security Income (SSI) payment amount for an eligible couple, plus $12.
Chart 3.5 - Ineligible Spouse Standard
Ineligible spouse in the deeming process Maximum Federal Supplemental Security Income (SSI) payment amounts for an eligible individual, divided by 2.
Chart 3.6 - SSI and State Supplement Maximum Income and Payment Amounts
SSI Countable Income Limit & Maximum Benefit for an Individual:
Living Arrangement A, D, E, F, G, I: Maximum Federal Supplemental Security Income (SSI) payment amount for an eligible individual
Living Arrangement C: Divide the Maximum Federal Supplemental Security Income (SSI) payment amount for an eligible individual by 3. Multiply the result by 2.
SSI Countable Income Limit & Maximum Benefit for a Couple:
Living Arrangement A, D, E, F, G, I: Maximum Federal Supplemental Security Income (SSI) payment amount for an eligible couple
Living Arrangement C: Divide the Maximum Federal Supplemental Security Income (SSI) payment amount for an eligible couple by 3. Multiply the quotient by 2.
INDIVIDUAL | COUPLE Living Arrangement s from Part 11 | State Supplement Benefit | State Supplement Countable Income Limit | State Supplement Benefit | State Supplement Countable Income Limit A | $10.00 | Sum of Column B and C | $15.00 | Sum of Column E and F C | $8.00 | Sum of Column B and C | $12.00 | Sum of Column E and F D | $49.00 | Sum of Column B and C | $273.00 | Sum of Column E and F E | $217.00 | Sum of Column B and C | $590.00 | Sum of Column E and F F | $234.00 | Sum of Column B and C | $636.00 | Sum of Column E and F G | $234.00 | Sum of Column B and C | $636.00 | Sum of Column E and F H | $10.00 | Sum of Column B and C | $20.00 | Sum of Column E and F I | $10.00 | Sum of Column B and C | $15.00 | Sum of Column E and F
If countable income is less than the SSI limit plus $20.00 for a particular “Living Arrangement,” the individual should apply for SSI in order to get the SSI benefit and State Supplement. If more, but less than the “State Supplement Income Limit” (plus $75 for living arrangements A and C), the individual can apply at Department of Health and Human Services for the State Supplement only.
Chart 3.7 - Income Limit for Adult Family Care Homes
This rate is set by the Office of MaineCare Sevices.
Previous year’s rate plus the product of the previous year’s rate multiplied by the current Social Security Administration’s Cost of Living Adjustment (COLA) percentage increase.
Chart 3.8 – Premiums for Special Benefits Waiver [Maine Section 1115 Health Care Reform Demonstration for Individuals with HIV/AIDS]
These premiums are set by the Office of MaineCare Services under the 1115 Health Care Reform Demonstration for Individuals with HIV/AIDS. This is a waiver agreement with the Centers for Medicare and Medicaid Services, and is set to expire December 31, 2028. There is an annual 5% increase in premium amounts.
Demonstration Year (DY) | Actual Premium, Income Level <150% FPL | Actual Premium, Income Level 150-200% FPL | Actual Premium, Income Level 200-250% FPL DY17 1/2019 – 12/2019 | $0 | $35.93 | $71.85 DY18 1/2020 – 12/2020 | $0 | $37.73 | $75.44 DY19 1/2021 – 12/2021 | $0 | $39.61 | $79.22 DY20 1/2022 – 12/2022 | $0 | $41.59 | $83.18 DY21 1/2023 – 12/2023 | $0 | $43.67 | $87.34 DY22 1/2024 – 12/2024 | $0 | $45.85 | $91.71 DY23 1/2025 – 12/2025 | $0 | $48.14 | $96.30 DY24 1/2026 – 12/2026 | $0 | $50.55 | $101.12 DY25 1/2027 – 12/2027 | $0 | $53.08 | $106.18 DY26 1/2028 – 12/2028 | $0 | $55.73 | $111.49
Chart 3.9 – Spousal Living Allowance for SSI Recipients
The difference between 100% of the Federal Poverty Level for a single individual and the Federal Supplemental Security Income (SSI) payment amount for an eligible individual, plus $55.
Note: For non-SSI recipients the amount of the Living Allowance is the difference between countable income and 100% federal poverty level.
Chart 3.10 – Premiums for MaineCare Katie Beckett Coverage Group
Family Income as a % of FPL Federal Poverty Level | Monthly Premium with Private Insurance | Monthly Premium without Private insurance 150 – 200% | $ 11 | $ 30 201 – 250% | $ 14 | $ 40 251 - 300% | $ 18 | $ 50 301 - 350% | $ 21 | $60 351 - 400% | $ 25 | $70 401 - 450% | $30 | $85 451 - 500% | $35 | $100 501 - 550% | $ 40 | $115 551 - 600% | $ 46 | $130 601 - 700% | $51 | $145 701 - 800% | $61 | $175 801 - 900% | $72 | $205 901 – 1000% | $84 | $240 1001-1200% | $96 | $275 1201-1400% | $117 | $335 1401-1600% | $138 | $395 1601-1800% | $159 | $455 1801-2000% | $182 | $520 2001-2500% | $207 | $590 2501%+ | $263 | $750
Chart 4
NURSING CARE LIMITS
Chart 4.1 Categorically Needy Nursing Care Status Income Limits
Maximum Federal Supplemental Security Income (SSI) payment amounts for an eligible individual multiplied by 3.
This is used as the income limit for:
Categorically Needy Nursing Care Status
Home and Community Based Waivers
Katie Beckett coverage
SSI - Related or Family - Related coverage group in a hospital for thirty consecutive days
Chart 4.2 Maximum Waiver Allowances
The amounts below are used as the maximum spousal allowance for Home and Community Based Waivers:
Maximum Federal Supplemental Security Income (SSI) payment amounts for an eligible individual.
Chart 4.3 Nursing Care Private Rate
The average nursing care private rate is the annual average monthly cost for a private patient to receive nursing facility care in the State of Maine as determined by the Department. This amount is used to calculate penalty periods for disposing of assets for less than fair market value on or after the look-back period.
$3917.00 eff. 8/1/1994
$6255.00 eff. 1/1/2006
$6778.00 eff. 1/1/2008
$7258.00 eff. 1/1/2009
$7667.00 eff. 9/1/2011
$8476.00 eff. 10/19/2014
Effective 6/1/2023 the average nursing care private rate is calculated using the previous year’s average rate as reported by nursing facilities on their most recent MaineCare Cost Report provided to the Division of Audit. To calculate the average nursing care private rate the Department shall add the total of all reported nursing facility daily rates and divide that sum by the total number of reported Nursing Facility rates. The average daily rates is multiplied by 31 to establish the average nursing care private rate. The average nursing care private rate is redetermined annually, with effective dates of June 1st, and posted online at https://www.maine.gov/dhhs/ofi/programs-services/health-care-assistance.
Chart 4.4 Spousal Impoverishment
Community Spouse Asset Allowance Maximum
$60,000 increased by the same percentage as the percentage increase in the consumer price index for all urban consumers (all items; U.S. city average) between September 1988 and the September before the calendar year involved.
Minimum Monthly Income Standard
150% of the Federal Poverty Level for a household of 2.
Monthly Excess Shelter Standard
30% of the Minimum Monthly Income Standard [above].
Maximum Monthly Income Allocation
$1500 increased by the same percentage as the percentage increase in the consumer price index for all urban consumers (all items; U.S. city average) between September 1988 and the September before the calendar year involved.
Chart 5
Protected Income Level
The following levels are effective 11/91:
Unit Size | Protected Income Level 1 | $ 315 2 | $ 341 3 | $ 458 4 | $ 575 5 | $ 691 6 | $ 808 7 | $ 925 8 | $ 1033 9 | $ 1150 10 | $ 1266
Add $116 for each additional person.
Chart 6
Fee Schedule for QDWI
If Monthly Countable Income is | Monthly Payment Required Is This % of the Current Medicare Part A Premium
150% FPL - 160% FPL | 10% 160.01% - 170% | 20% 170.01% - 180% | 30% 180.01% - 190% | 40% 190.01% - 200% | 50% Over 200% | Not Eligible
Countable income is determined using SSI - Related rules.
Chart 7
CUB CARE
(Repealed by adoption filing 2023-123 effective August 15, 2023.)
The Maine Department of Health and Human Services is responsible for administering the MaineCare Program in compliance with Federal and State statutes and administrative policies. It is also responsible for state funded assistance programs found within this manual. Within the Department, the Office for Family Independence (OFI) establishes and applies written policies and procedures for taking applications and determining eligibility for assistance, consistent with the objectives of the Program. It also respects the rights of individuals under the United States Constitution, the Social Security Act, Title VI of the Civil Rights Act of 1964, the Americans with Disabilities Act and all other relevant provisions of Federal and State laws which do not result in practices that violate the individual's privacy or personal dignity. The Department further holds any policies or procedures developed at the regional level to be consistent.
Title VI of the Civil Rights Act of 1964 and the Americans with Disabilities Act states that no person shall be excluded from participation, be denied benefits, or be subjected to discrimination on the grounds of race, color, national origin, sex, gender orientation, religion or disability under any program or activity receiving federal financial assistance. Therefore, the programs of the Department, like every program or activity receiving financial assistance from the Federal Department of Health and Human Services, must be operated in compliance with the law.
In accordance with the Americans with Disabilities Act, no qualified individual with a disability will, by reason of such disability, be subjected to discrimination; or be excluded from participation or be denied the benefits of the services, programs or activities of the Maine Department of Health and Human Services.
Section 1.1: Definitions
“Assistance unit” means the individuals whose need the department considers when determining whether an applicant or recipient is eligible for program benefits.
An “Administrative Hearing” (Hearing) is a hearing between a participant and the Department that is less formal than a proceeding in traditional courtroom, but there still is an authority presiding and testimony and evidence are presented by both sides. A Hearings Officer or the Commissioner of the Department will oversee the Administrative Hearing by hearing both sides and review the action taken by the Department. The purpose of the Administrative Hearing is to ensure that Federal and State rules have been applied correctly. A hearing decision will be made in writing and provided to the participant and the Department within the timelines allotted in the Appendix.
Federally Facilitated Marketplace: The federally facilitated marketplace (FFM) is a website established and operated by the US federal government to facilitate the purchase of health insurance in accordance with the Patient Protection and Affordable Care Act.
“Intentional Program Violation” means that a recipient, applicant, or any other individual in the “Assistance Unit” has intentionally misrepresented facts (including, but not limited to such facts as living arrangement, income, or assets) in order to receive MaineCare, and the recipient, applicant, or any other individual in the Assistance Unit would not have been eligible for MaineCare if the Department had been notified of the correct facts, or of a material change in facts. This includes, but is not limited to:
A. False or misleading statements or representations, or withholding of facts, or
B. An action intended to mislead, misrepresent, conceal or withhold facts.
“Overpayment” means program benefits that exceed the amount of program benefits, if any, for which an individual or assistance unit is actually eligible when the department or a court has determined that the benefits were provided as a result of an Intentional Program Violation by the individual.
“Program benefits” means payments for medical services or durable medical equipment and supplies, and/or the durable medical equipment and supplies, reimbursed by the department under the MaineCare program established pursuant to 22 MSRA ch. 855.
The Department of Health and Human Services, in accordance with Federal Regulation (42 CFR 431.306) and State statutes, must maintain the individual's information in a manner which will ensure that this information is restricted to persons or agency representatives who are subject to standards of confidentiality comparable to those of the Department.
Section 2.1: Release of Information
Information from the case record will be released under the following circumstances:
I. The individual has the right to review information in their case record at any time. When the medical source requests that the medical information be kept confidential, that information may not be reviewed by the individual.
II. All information pertaining to a decision of eligibility for assistance, including medical and social data for preparation of an Administrative Hearing will be made available to the individual or the individual's representative. If the individual is being represented by an attorney, permission to release information to the attorney must be obtained in writing from the individual.
III. Financial information relating to eligibility will be given to general assistance administrators if necessary for making a determination of granting general assistance.
IV. Information relating to whether an individual is a recipient in a particular month will be given to hospitals, physicians, pharmacists, and other medical providers inquiring in order to determine whether to provide their service under MaineCare. The address of the individual is not to be released.
V. Information necessary for other Offices within the Department to administer their programs may be given. These Offices include Office of Child and Family Services (OCFS) – Child Protective Services, Office of Aging and Disability Services (OADS) – Adult Protective Services, Division of Support Enforcement and Recovery (DSER), Fraud Investigation and Recovery Unit (FIRU), the Preventive Health Program (PHP), and the Division of Administrative Hearings. Information may also be provided to other Offices within DHHS if there is a written Memorandum of Understanding between OFI and that Office.
VI. For those agencies having a contract with the Department information may be released that is needed for the agency to fulfill the terms of the contract. Agencies include Home and Community Based Waiver agencies and Community Action Programs.
VII. In the event of the issuance of a subpoena or order from the court for the case record or for any agency representative to testify concerning an applicant or recipient, the Department's attorneys will call the Court's attention to the statutory provisions and the regulations against disclosure of information. The decision in regard to release of information will be with the presiding judge.
VIII. Pursuant to 42 CFR §435.1200, for Members or individuals who have been determined not eligible for Medicaid, the Department will transfer via secure electronic interface, the individual’s electronic account to other insurance affordability programs, such as the federally facilitated marketplace.
Section 2.2: Written Release of Information
With all other requests, a written release from the individual is required prior to sharing the information. Unless otherwise specified any written release of information is valid for one year from the date of signature by the individual. The release of information must specify the information to be released and to whom.
I. Release of medical reports to general assistance administrators will be made only if the individual has signed a written release.
II. Information will be made available upon receipt of written authorization from the individual (or adult family head in the case of children) giving the Department authorization to release information to the following:
A. Federal and State legislators;
B. attorneys;
C. social or financial service agencies requesting information beyond eligibility dates, or, if under contract with the Department, information beyond that necessary to administer their program.
III. Information about whether the individual is receiving MaineCare, the number of children in the assistance unit and the address of the children will be made available to absent parents inquiring about the status of the family only with written permission of the caretaker relative.
Section 2.3: Information from an external source
For DHHS to obtain information:
I. the Eligibility Specialists must inform the individual of the Department’s need for collateral information; and
II. receive a signed release form from the individual identifying the information being requested and from whom.
Information in case records and computer files will be used only for Department business, never for obtaining information about friends, relatives or neighbors. Employees of the Department are not permitted to determine their own eligibility or that of their immediate family.
The names of individuals supplying information who wish to remain anonymous will not be kept in the case record.
Under certain circumstances referral to other Offices and Divisions within the Department of Health and Human Services are to be made. These include the Office of Child and Family Services (OCFS), the Office of Aging and Disability Services (OADS) and the Division of Fraud Investigation and Recovery Unit (FIRU) within OFI.
Section 3.1: Referrals to Child and Adult Protective Services
In compliance with Federal and State statutes, when information is brought to the attention of a staff member or there is reasonable cause to suspect abuse, neglect or exploitation, an immediate referral will be made to the Child or Adult Protective Unit which will investigate the suspected abuse.
Section 3.2: Referral to the Fraud Investigation and Recovery Unit (FIR) from the Eligibility Unit
If it appears that a recipient has purposely misrepresented actual circumstances (such as living arrangement, income, or assets) in order to receive MaineCare, and the individual would not have been eligible had the proper information been available at the time of application, re-determination of eligibility, or within ten days of the change in circumstances, a referral to the Fraud Investigation Unit will be made.
The report will include:
I. a detailed explanation of the misrepresentation and the effect it had on eligibility.
II. a claims history indicating the services that should not have been paid.
Section 3.3: Referrals to the Fraud Investigation and Recovery Unit (FIR) from an outside source
Complaints received directly by the Fraud Investigation and Recovery Unit may be referred to the Attorney General’s Office if it is determined that:
I. the individual was enrolled in MaineCare at the time alleged fraud occurred;
II. it appears that the individual has purposely misrepresented actual circumstances to receive MaineCare;
III. the individual would not have remained eligible if the complaint is valid; and
IV. MaineCare paid for services during the time period in question.
The name of individuals supplying information who wish to remain anonymous will not be kept in the case record.
In those instances when an individual reports the loss or non-receipt of a medical identification card, the Department will issue a replacement card.
Requests may be made by telephone, in writing, or in person.
OFI will issue replacement cards for those individuals for whom they maintain case records or for SSI recipients. Child welfare recipients will be referred to Office of Child and Family Services (OCFS).
Medical Services provided outside of the State of Maine are coverable under the following circumstances:
I. Individuals are eligible for payment of services to qualified providers as long as the provider is located within fifteen miles of the Maine-New Hampshire border or within five miles of the Maine-Canada border.
II. Individuals absent from the State are eligible for coverage of emergency services. Routine medical services usually require prior authorization from the Office of MaineCare Services (OMS). In both circumstances the provider will need to enroll as a MaineCare provider.
State law (22 MRSA §3173) requires the Department of Health and Human Services to inform low-income households of the availability and benefits of MaineCare and provide reasonable and convenient access to the program. The Department publishes information explaining covered services and eligibility.
An Administrative Hearing (Hearing) is an informal conference held by the Commissioner of the Department, or a Hearing Officer, to review the action taken by the Department in order to ensure that Federal and State policy have been applied correctly. This right is basic throughout all of the public assistance programs. (Administrative Hearings regulations for all of DHHS is found at 10-144 in the Code of Maine Regulations Chapter 1). If the Commissioner authorizes another agent to handle the hearing, the Hearing Officer must be:
I. impartial and not have participated in the action causing dissatisfaction;
II. sufficiently skilled in interviewing to obtain evidence and the facts necessary for a fair determination; and
III. qualified to evaluate all evidence fairly and realistically, to explain to the individual the policies under which the Department operated and to interpret and inform the Department of any evidence of unsound, unclear or inequitable policies or practices.
Written notification of the right to a hearing is given to all interested parties through the use of pamphlets and informational materials.
Every written notification of Department action on eligibility will include:
I. the right to a hearing;
II. the method by which a hearing can be obtained; and
III. the right to be represented by legal counsel, relative, friends, or other persons. The Department cannot pay for legal services.
Section 7.1: Requesting an Administrative Hearing
Federal and State laws assure that any individual or the individual's representative who believes that proper consideration has not been given to circumstances surrounding a request for assistance may request a hearing. Any oral or written request made by the individual or their representative to the Department that they want an opportunity to present the case to a higher authority is a request for a hearing.
All complaints which are not clear requests for a hearing will be answered by a personal contact or in writing by the Eligibility Specialist, Supervisor, or member of Central Office staff and will explain the individual's right to a hearing. If the individual is satisfied with the adjustment or explanation, activity on the complaint will end. If not, the individual will be offered the opportunity for a hearing.
The Department must assure that the individual understands the process. When a request is made, the Department will not limit or interfere with the individual's rights in any way. In fact, the emphasis of the Department will be on helping the individual submit the request and prepare the case. The Department's regional office will provide information regarding legal services available in the community to assist the individual in representation at hearings.
The Department may request that the Division of Administrative Hearings deny or dismiss a request for a hearing when:
I. the request is withdrawn in writing by the individual or individual's representative;
II. the sole issue is one of State or Federal law requiring automatic adjustment for groups of individuals unless the reason for an individual's appeal is disagreement of facts affecting eligibility (such as incorrect computation); or
III. the hearing is abandoned. Abandonment occurs when the individual or the individual's representative fails to appear at the hearing without a reason acceptable to the Hearing Officer.
The Department may respond to a series of individual requests for hearings by requesting the Division of Administrative Hearings conduct a single group hearing. The Department will consolidate only cases in which the sole issue involved is one of a single policy issue. If individuals request a group hearing on such an issue, the Department will grant it. In all group hearings, the policies governing hearings will be followed. Thus, individuals will be permitted to present their own cases and to be represented. If, at any time, an individual scheduled for a group hearing wants to withdraw and have an individual hearing, the request must be made to the Division of Administrative Hearings.
Any request for a hearing must be received by the local office within thirty days (plus two days for mail) starting with the date on the written notice of eligibility unless the Department decides to grant an extension of time.
The hearing process will take no longer than sixty days from the date of the initial request for the hearing except when the individual requests a delay. If the request for a delay is granted, additional time may be added to the sixty days.
A request for a hearing will be acknowledged in writing within five days of its receipt by the local office. The notice will be sent at least ten days prior to the hearing to allow for preparation of the case.
When additional medical information is requested by the individual, it will be obtained at Department expense from a medical source satisfactory to the individual. The Hearing Officer can also consider the physician's report or can request additional evidence. The medical report will be made in writing or by personal testimony for the hearing record. When the hearing involves medical issues, a medical assessment other than that of the persons involved in making the original decision will be obtained and made a part of the record if the Hearing Officer or the individual considers it necessary.
Section 7.2: Continuation of Benefits
If the individual requests a hearing at any time during the Adverse Action Notice Period, assistance will be continued until the written hearing decision is rendered. The Adverse Action Notice Period is the fifteen day period (ten days for notice plus five days for mail), starting with the date of the written notice of eligibility.
If a hearing is requested after the fifteen day period, assistance will not be continued or reinstated at its previous level pending a decision, unless the beneficiary shows that he or she did not receive the notice within the 5-day mailing.
Closure of temporary coverage is a denial and continuation of benefits cannot be made.
Section 7.3: Conducting an Administrative Hearing
The Eligibility Specialist and other Department representatives involved in the decision will participate in the hearing. All participants will testify under oath.
Either party may subpoena witnesses and evidence by request through the Division of Administrative Hearings Office. The party requesting the subpoena will bear any expenses of issuance and costs of reimbursement to witnesses. For the most up to date information about the procedure of administrative hearings, please see the Administrative Hearing Unit Manual.
All hearings will:
I. be conducted privately and be open only to the individual, anyone present at the individual's request, and members of the Department's staff, or others selected by the Hearing Officer for their participation in the hearing;
II. be conducted informally without technical rules of evidence. Hearings will be subject to the requirement of due process, the regulations of the Division of Administrative Hearings and the Administrative Procedure Act. All witnesses will testify under oath;
III. be opened by the Hearing Officer who will make a statement of points in issue, give all participants an opportunity to present relevant oral or written testimony or documentary evidence, offer rebuttal, question witnesses, examine all evidence presented at the hearing, and establish competency of witnesses offering subjective or technical opinions;
IV. be recorded to be available to members of the Department and to the individual or individual's representative. All documentary evidence submitted as exhibits at the hearing will be available;
V. be concluded when the Hearing Officer and the individual or individual's representative are satisfied that all available relevant evidence has been introduced and properly examined; and
VI. result in a decision based exclusively on evidence or testimony presented at the hearing.
Section 7.3.1: The Hearing Officer’s review of the Department’s decision shall include consideration of:
I. the Agency's failure to act with reasonable promptness. This includes undue delay in reaching a decision about eligibility or refusal to consider a request for assistance and termination or reduction of assistance.
II. an Agency decision regarding:
A. eligibility for assistance in both initial and subsequent determinations;
B. the level of coverage granted.
Section 7.3.2: The individual or the individual's representative will have the opportunity to:
I. examine all documents and records pertinent to the hearing;
II. present the case with or without the aid of others;
III. bring witnesses;
IV. establish all pertinent facts and circumstances;
V. present any relevant arguments without interference;
VI. question or refute any testimony or evidence; and
VII. confront and cross examine adverse witnesses.
Any information shared with the Hearing Officer must also be shared with the individual or the individual’s representative.
Section 7.3.3: Following the Hearing, a written decision will be prepared by the Hearing Officer.
The decision will contain:
I. a statement of the issue;
II. a list of participants;
III. relevant facts brought out at the hearing and items introduced into evidence;
IV. pertinent provisions in Department's policy governing the decision; and
V. the decision and the basis for the decision.
A copy of the hearing decision will be sent to the individual, the individual's representative, and the regional office.
The Department is bound by the hearing decision. The decision is applied to the case in question only.
Section 7.4: Implementing Results
The hearing decision will be implemented upon receipt of the written decision.
If the individual files an appeal to Superior Court benefits will continue if directed by the Attorney General or the court.
Section 7.5: Judicial Review
Within five days of the written decision by the Hearing Officer, the copy of the decision and notice of the individual's rights to judicial review under Maine Administrative Procedure Act 5 M.R.S.A., Sec. 11001 et seq. will be mailed to the individual and the individual's representative. The notice will also advise the individual that to take advantage of this right, a petition for review with the Superior Court must be filed within thirty days of the receipt of the decision.
For additional information on the preparation of a hearing, see Appendix I -Preparation for the Hearing Process.
Material is kept for auditing purposes for three years. Material over three years old may be destroyed except for the first application which should be kept even if it is over three years old.
Individual case records are not to be filed in Archives for historical preservation and future review by historians or anyone else. Such retention has no bearing on the administration of MaineCare.
The only exception to this procedure is a case which has been referred to the Fraud Investigation and Recovery Unit (FIR) or Attorney General for collection or prosecution purposes. These case records shall be clearly marked "Do Not Destroy".
Section 9.1 Intentional Program Violation
means that a recipient, applicant, or any other individual in the “Assistance Unit” has intentionally misrepresented facts (including, but not limited to such facts as living arrangement, income, or assets) in order to receive MaineCare, and the recipient, applicant, or any other individual in the Assistance Unit would not have been eligible for MaineCare if the Department had been notified of the correct facts, or of a material change in facts. This includes, but is not limited to:
A. False or misleading statements or misrepresentations, concealment, or withholding of facts, or
B. An act intended to mislead, misrepresent, conceal, or withhold facts or propound a falsity.
Section 9.2 Determining the Overpayment.
“Overpayment” means program benefits that exceed the amount of program benefits, if any, for which an individual or assistance unit is actually eligible when the department or a court has determined that the benefits were provided as a result of an Intentional Program Violation by the individual. Overpayments are calculated as follows:
A. For excess assets, the amount subject to recovery is the lesser of:
a. The amount of the payment made on behalf of the individual; or
b. The difference between the actual amount of countable resources and the applicable resource limit.
B. For excess income, the amount subject to recovery is the total amount of program benefits made on behalf of the individual during the months of the overpayment period.
C. For combinations of excess assets and excess income, the amount subject to recovery is the greater of either A. or B. in this Section.
D. For misrepresentation of circumstances other than income and assets, the amount subject to recovery is the total amount of payments made on behalf of the individual during the months of the overpayment period.
E. For Medically-Needy cases, as described in Part 10 of 10-144 CMR Chapter 332, the amount subject to recovery is the lesser of:
a. The amount of program benefits made on behalf of the individual; or
b. The difference between the amount of the deductible in effect during the overpayment period and the correct amount of the deductible.
F. Situations involving individuals receiving long-term care and waiver services:
a. Excess Income –
i. If the individual should not have been made eligible for MaineCare, the amount subject to recovery is the amount of program benefits made on behalf of the individual.
ii. If the individual was correctly made eligible for MaineCare but the cost of care was incorrectly calculated, the amount subject to recovery is the difference between the amount of the correct cost of care and the cost of care that was in effect during the overpayment period.
b. Excess Resources –
i. The amount subject to recovery is the difference between the actual amount of countable resources and the applicable resource limit.
ii. The individual may choose to make a payment of a lump sum to the long term care facility if the increase will reduce the resources to the appropriate limit. The reduction in resources shall be completed in one calendar month.
Section 9.3 Notice of Overpayment/IPV.
The eligibility office in cooperation with the Office of MaineCare Services shall provide the following information to the individual and/or assistance unit:
A. a detailed explanation of the misrepresentation and the effect it had on eligibility.
B. a claims history indicating the services that should not have been paid.
C. a request that the applicant contact the Office for Family Independence (OFI) within 10-days to discuss repayment of the benefits issued.
D. deadlines and methods for requesting an administrative hearing.
E. closings, denials, and eligibility notices will be handled according to Part 2 Sections 14 and 15.
Section 9.4 Administrative Hearing –
The Department will provide instructions on how to request an Administrative Hearing consistent with Part 1 Section 7 above.
Section 9.5 Referral to Fraud Investigation & Recovery Unit (FIRU) for recovery of overpayments described in Section 9.2
The OFI will send a copy of the above-referenced notice of over-payment to the Fraud Investigation and Recovery Unit:
A. if the individual or assistance unit does not appeal the department’s findings; or
B. the final written decision by the Administrative Hearing Officer finds in favor of the department and the individual does not request a judicial review; or
C. judicial review finds in favor of the department.
MaineCare is the name used by the State of Maine for programs that help individuals pay for health care costs. The Department’s goal is to assist Maine residents in obtaining the benefits to which they are entitled. The programs are:
Medicaid (Title XIX of the Social Security Act). To be enrolled in Medicaid an individual must be both categorically and financially eligible. Each category has its own eligibility rules. Medicaid includes coverage for people living in the community or living in a long-term care facility.
Categorically Needy – This Medicaid category is made up of different mandatory and optional coverage groups covered within the state plan. An individual qualifies for Medicaid in this category if they meet the requirements of one of the Categorically Needy coverage groups.
Medically Needy – This Medicaid category provides coverage for individuals who meet the non-financial requirements of a Categorically Needy group but are financially ineligible. Coverage is gained by meeting a deductible.
Medicaid Waiver Groups – These are optional coverage groups approved by the Center for Medicare and Medicaid Services (CMS) under which an individual can become enrolled in Medicaid who might not otherwise be eligible. Examples are the Home and Community Based Waivers and the HIV Waiver.
Children’s Health Insurance Program (CHIP), formerly known as Cub Care in Maine until 2024, is authorizing under Title XXI of the Social Security Act – This program provides coverage for children under the age of 19 within certain income limits. CHIP also provides coverage to pregnant individuals who are eligible for Medicaid but for their noncitizen status.
Medicare Savings Program (Buy-In) – This Medicaid category is a benefit for those who are entitled to Medicare Part A and who meet certain income criteria. Depending on income, the benefit is payment of Medicare Part B premium or payment of Medicare Part A and B premiums as well as coinsurance and deductibles.
The Office for Family Independence (OFI) also administers the following additional benefits under MaineCare:
Health Insurance Purchase Option (HIPO) – This program provides 18 months of extended health coverage to children under the age of 19 who are no longer eligible for MaineCare due to changes in income. (See 10-144 C.M.R. Ch. 335.)
Coverage for Noncitizens Under Age 21 – This state funded program provides coverage to individuals under the age of 21 who would be eligible for Medicaid but for their noncitizen status.
Low Cost Drugs for the Elderly and Disabled (DEL) – This state funded program assists elderly or disabled individuals with the cost of their medications. (See 10-144 C.M.R. Ch. 333.)
Maine Rx Plus – This state funded program assists Maine residents with the cost of their medications. Income guidelines are higher than under DEL and the benefit is less. (See 10-144 C.M.R. Ch. 334.)
State Supplement – This is a cash payment to SSI recipients, and individuals who would otherwise be eligible for SSI except for income or citizenship criteria. (See Part 11.)
Spousal Living Allowance – This is a cash payment to a spouse of a resident of a Residential Care Facility or Cost Reimbursed Boarding Home. The spouse must meet income and asset criteria. (See Part 12 Section 5.)
To be eligible for MaineCare an individual must fall within a category. With the exception of individuals who qualify for Medicaid under a waiver or for the Medicare Savings Program, individuals must fall into one of the Categorically Needy/Medically Needy coverage groups. Each coverage group has specific eligibility criteria and individuals can meet the eligibility criteria of more than one coverage group at the same time.
Once the Department has determined that an individual meets the criteria of one or more coverage groups possible assistance units for each coverage group are identified.
Choosing a coverage group:
An assistance unit is an individual or group enrolled in or applying for MaineCare. The assistance unit also includes individuals who are not covered, or not applying for coverage, but whose income, assets, and/or needs are considered in determining eligibility.
Individuals are placed in the coverage group and assistance unit that is most beneficial to them. An individual can be included in more than one assistance unit at the same time to ensure that everyone who wants coverage gets coverage. When not everyone who wants coverage can be covered and a decision needs to be made as to which family members will be covered, the Department shall inform the individual of the coverage options and give them the opportunity to choose which coverage is preferred.
MaineCare and CHIP applicants must declare their United States citizenship or qualifying noncitizen status and have their status verified to receive MaineCare benefits. An individual who is not a citizen of the United States may be eligible for full MaineCare benefits, or they may be eligible for emergency services only.
Section 3.1 Verification of Citizenship and Identity
I. Unless exempted below in Paragraph II(A) through (F), all members of a household applying for Medicaid and CHIP must verify citizenship and identity. The Department will attempt to verify citizenship or qualifying noncitizen status through electronic services before requiring verification from the applicant or member.
II. The requirement to verify U.S. citizenship and identity does not apply to:
A. Current recipients of Supplemental Security Income (SSI).
B. Current recipients of Social Security benefits, based on the individual’s disability.
C. Individuals entitled to or enrolled in Medicare.
D. Children who receive child welfare assistance under IV-B of the Social Security Act or foster care assistance under IV-E of the Social Security Act. This exemption is for the child only, not the family providing the care.
E. A newborn whose mother receives Medicaid at the time of birth.
F. Individuals while covered under Presumptive Eligibility.
G. Individuals whose citizenship or eligible noncitizen status has been verified by the Department and for whom no change in status has been reported to the Department.
III. Applicants and household members who declare United States citizenship or a qualifying noncitizen status, who are otherwise eligible and only pending for verification of citizenship or noncitizen status, will be granted a reasonable opportunity period of 90 days from the date of request for verification to provide documentation necessary to prove citizenship or qualifying noncitizen status. MaineCare or CHIP coverage will be provided during the reasonable opportunity period, starting with the first day of the month of application.
A reasonable opportunity period is not provided if an individual does not declare U.S. citizenship or a qualifying noncitizen status.
The reasonable opportunity period is defined as follows:
A. It begins the date after the member receives notice informing them they need to provide documentation of citizenship or qualifying noncitizen status. The date the notice is received is 5 days after the date on the notice.
B. It ends on the earlier of the date the Department verified the individual’s citizenship or immigration status or at the end of the 90-day period if verification of citizenship or satisfactory noncitizen status was not obtained.
The Department may extend the reasonable opportunity period if the individual is making a good faith effort to obtain any necessary documentation, or if the Department needs more time to complete the verification process.
If the applicant does not provide documentation necessary to verify citizenship or qualifying noncitizen status of the applicant and household members within 90 days, benefits for unverified household members will end. A reasonable opportunity period will be provided on subsequent applications submitted by or on behalf of the applicant or household members.
IV. Failure to declare or prove citizenship or qualifying noncitizen status may result in ineligibility for Medicaid or CHIP. Emergency Services may be provided to an applicant who does not declare or is unable to prove declared qualifying noncitizen status within the reasonable opportunity period.
If an individual within a household is not eligible due to inability to prove citizenship, identity or noncitizen status, the individual will still be counted as part of the household and that person’s income and assets will be included in determining eligibility for the rest of the household.
Section 3.2 Citizenship and Identity Requirements
I. A United States citizen is:
A. An individual born in the United States or its territories, including Puerto Rico, the Virgin Islands, Guam, and the Northern Mariana Islands, except those born to a foreign diplomat, and who otherwise qualifies for U.S. citizenship under §301 et seq. of the Immigration and Nationality Act; [8 U.S.C. §§ 1401-1409].
B. An individual born of a parent who is a U.S. citizen or who otherwise qualifies for U.S. citizenship under §301 et seq. of the Immigration and Nationality Act; [8 U.S.C. §§ 1401-1409].
C. A naturalized citizen.
D. A national (both citizen and noncitizen national):
1. Citizen National. A citizen national is an individual who otherwise qualifies as a U.S. citizen under §301 et seq. of the Immigration and Nationality Act. [8 U.S.C. §§ 1401-1409].
2. Noncitizen National. A noncitizen national is an individual who was born in one of the outlying possessions of the United States, including America Samoa and Swain’s Island, to a parent who is a noncitizen national.
II. Primary Verification of Citizenship and Identity
The following documents may be accepted as proof of both citizenship and identity because each contains a photograph of the individual named in the document, and the citizenship and identity of the individual have been established by either the U.S. or a state government. Primary verifications satisfy both citizenship and identity requirements:
A. U.S. passport, including U.S. passport card: a U.S. passport need not be currently valid to be accepted as evidence of U.S. citizenship, if it was originally issued without limitation. However, a passport that was issued with limitation and is not currently valid may be used as proof of identity only. U.S. passports issued after 1980 show only one person. However, spouses and children were sometimes included on one passport through 1980. The citizenship and identity of the included person can be established when one of these passports is presented.
B. Certificate of Naturalization (Department of Homeland Security form N-550 or N570);
C. Certificate of U.S. Citizenship (Department of Homeland Security form N-560 or N561); or
D. Tribal enrollment documents, evidencing membership or affiliation with a Federally recognized tribe.
III. Secondary Verifications of Citizenship
If primary verification from the list in Paragraph II of this section is unavailable, the person should provide satisfactory documentary verification from Paragraph VI of this section to establish identity, and satisfactory verification of citizenship from the list below:
A. A U.S. public birth certificate showing birth in one of the 50 States, the District of Columbia, Puerto Rico (if born on or after January 13, 1941), Guam, the Virgin Islands of the U.S., American Samoa, Swain’s Island, or the Northern Mariana Islands (after November 4, 1986 (NMI local time)). The birth record document may be issued by the state, commonwealth, territory, or local jurisdiction. It must have been recorded before the person was 5 years of age. (A delayed birth record document that is amended after 5 years of age is considered fourth level evidence of citizenship. See section V, paragraph B.
B. If the document shows the individual was born in Puerto Rico, Guam, the Virgin Islands of the U.S., or the Northern Mariana Islands before these areas became part of the U.S., the individual may be a collectively naturalized citizen. Collective naturalization occurred on the dates listed for each of the Territories. The following will establish U.S. citizenship for collectively naturalized individuals:
1. Puerto Rico
a. evidence of birth in Puerto Rico and the person’s statement that they were residing in the U.S., a U.S. possession, or Puerto Rico on January 13, 1941; or
b. evidence that the person was a Puerto Rican citizen and the person’s statement that they were residing in Puerto Rico on March 1, 2017 and that they did not take an oath of allegiance to Spain.
2. U.S. Virgin Islands
a. evidence of birth in the U.S. Virgin Islands, and the person’s statement of residence in the U.S., a U.S. possession or the U.S. Virgin Islands on February 25, 1927; or
b. the person’s statement indicating residence in the U.S. Virgin Islands as a Danish citizen on January 17, 2017 and residence in the U.S., a U.S. possession, or the U.S. Virgin Islands on February 25, 1927, and that the person did not make a declaration to maintain Danish citizenship; or
c. evidence of birth in the U.S. Virgin Islands and the person’s statement indicating residence in the U.S., a U.S. possession, or Territory or the Canal Zone on June 28, 1932.
3. Northern Mariana Islands (NMI) (formerly part of the Trust Territory of the Pacific Islands {TTPI}):
a. evidence of birth in the NMI, TTPI citizenship and residence in the NMI, the U.S., or a U.S. Territory or possession on November 3, 1986 (NMI local time) and the person’s statement that they did not owe allegiance to a foreign state on November 4, 1986 (NMI local time); or
b. evidence of TTPI citizenship, continuous residence in the NMI since before November 3, 1981 (NMI local time), voter registration prior to January 1, 1975 and the person’s statement that they did not owe allegiance to a foreign state on November 4, 1986 (NMI local time); or
c. evidence of continuous domicile in the NMI since before January 1, 1974 and the applicant's statement that they did not owe allegiance to a foreign state on November 4, 1986 (NMI local time).
d. If a person entered the NMI as a nonimmigrant and lived in the NMI since January 1, 1974, this does not constitute continuous domicile and the person is not a U.S. citizen.
C. A Certification of Report of Birth (DS-1350)
The Department of State issues a DS-1350 to U.S. citizens in the U.S. who were born outside the U.S. and acquired U.S. citizenship at birth, based on the information shown on the FS-240. When the birth was recorded as a Consular Report of Birth (FS-240), certified copies of the Certification of Report of Birth Abroad (DS-1350) can be issued by the Department of State in Washington, D.C. The DS-1350 contains the same information as that on the current version of Consular Report of Birth FS240. The DS-1350 is not issued outside the U.S.
D. A Report of Birth Abroad of a U.S. Citizen (Form FS-240)
The Department of State consular office prepares and issues this. A Consular Report of Birth can be prepared only at an American consular office overseas while the child is under the age of 18. Children born outside the U.S. to U.S. military personnel usually have one of these.
E. A Certification of Birth Issued by the Department of State (Form FS-545 or DS1350)
Before November 1, 1990, Department of State consulates also issued Form FS-545 along with the prior version of the FS-240. In 1990, U.S. consulates ceased to issue Form FS-545. Treat an FS-545 the same as the DS-1350.
F. A U.S. Citizen I.D. Card
This form was issued as Form I-197 until the 1980s by INS. INS issued the I-179 from 1960 until 1973. It revised the form and renumbered it as Form I-197. INS issued the I-197 from 1973 until April 7, 1983. INS issued Form I-179 and I-197 to naturalized U.S. citizens living near the Canadian or Mexican border who needed it for frequent border crossings. Although neither form is currently issued, either form that was previously issued is still valid.
G. A Northern Mariana Identification Card (I-873)
The former Immigration and Naturalization Service (INS) issued the I-873 to a collectively naturalized citizen of the U.S. who was born in the NMI before November 4, 1986. The card is no longer issued, but those previously issued are still valid.
H. An American Indian Card (I-872) issued by the Department of Homeland Security (DHS) with the classification code “KIC”
DHS issues this card to identify a member of the Texas Band of Kickapoos living near the U.S./Mexican border. A classification code of “KIC” and a statement on the back denote U.S. citizenship.
I. A final adoption decree showing the child's name and U.S. place of birth
In situations where an adoption is not finalized and the state in which the child was born will not release a birth certificate prior to final adoption, a statement from a state-approved adoption agency that shows the child's name and U.S. place of birth is acceptable. The adoption agency must state in the certification that the source of the place of birth information is an original birth certificate.
J. Evidence of U.S. Civil Service employment before June 1, 1976
The document must show employment by the U.S. government before June 1, 1976. Individuals employed by the U.S. Civil Service prior to June 1, 1976 had to be U.S. citizens.
K. U.S. Military Record showing a U.S. place of birth
The document must show a U.S. place of birth (for example a DD-214 or similar official document showing a U.S. place of birth.)
L. A verification with the Department of Homeland Security's Systematic Alien Verification for Entitlements (SAVE) database. Inclusion in this database could prove citizenship through naturalization.
M. Evidence of meeting the automatic criteria for U.S. Citizenship outlined in the Child Citizenship Act of 2000.
N. Evidence of meeting the automatic criteria for U.S. citizenship under the provisions of the INA in effect on the person’s birthdate or adoption date, if the person’s birthdate or adoption date was prior to the February 27, 2001 enactment date of the Child Citizenship Act of 2000 (citizenship laws are not retroactive, so the law applicable at the time the person was born or adopted applies, even if that law was subsequently repealed and replaced by a new section).
IV. Third-Level Verification of Citizenship
If verification from the lists in Paragraphs II and III of this section is unavailable and the person claims a U.S. place of birth, the person should provide satisfactory verification from Paragraph VI of this section to establish identity, and satisfactory verification of citizenship from the list below:
A. Extract of a hospital record on hospital letterhead, indicating a U.S. place of birth. The hospital record must have been established at the time of the person’s birth and created five years before the initial application date for Medicaid or CHIP (For children under age 16, the document must have been created near the time of birth or five years before the date of application). A souvenir “birth certificate” issued by a hospital does not satisfy this requirement.
B. Life, health, or other insurance record showing a U.S. place of birth. The record must have been created at least five years before the initial application date for Medicaid or CHIP.
C. Religious record recorded in the U.S. within three months of birth showing the birth occurred in the U.S. and showing either the date of the birth or the individual's age at the time the record was made. The record must be an official record recorded with the religious organization. (Entries in a family bible are not considered religious records.)
D. Early school record showing a U.S. place of birth. The school record must show the name of the child, the date of the admission to the school, the date of birth, a U.S. place of birth, and the name(s) and place(s) of the birth of the applicant's parents.
V. Fourth-Level Verification of Citizenship
If verification from the lists in Paragraphs II, III, and IV of this section is unavailable and the person claims a U.S. place of birth, the person should provide verification from Paragraph VI of this section to establish identity, and satisfactory documentary evidence of citizenship from the list below:
A. Federal or State census record showing U.S. citizenship or a U.S. place of birth. The census record must also show the applicant’s age.
Census records from 1900 through 1950 contain certain citizenship information. To secure this information, complete a Form BC-600, Application for Search of Census Records for Proof of Age. Add in the remarks portion “U.S. citizenship data requested”. Also add that the purpose is for Medicaid and CHIP eligibility.
B. One of the following documents that show a U.S. place of birth and was created at least five years before the application for Medicaid and CHIP:
1. Seneca Indian tribal census record;
2. Bureau of Indian Affairs tribal census records of the Navajo Indians;
3. U.S. State Vital Statistics official notification of birth registration;
4. A delayed U.S. public birth record that is recorded more than five years after the person's birth;
5. Statement signed by the physician or midwife who was in attendance at the time of birth; or
6. Bureau of Indian Affairs Roll of Alaska Natives.
C. Institutional admission papers from a nursing facility, skilled care facility or other institution, showing a U.S. place of birth, created at least five years before the initial application.
D. Medical (clinic, doctor, or hospital) record showing a U.S. place of birth. The record must have been created at least five years before the initial application date for Medicaid or CHIP. (For children under age 16, the document must have been created near the time of birth or five years before the date of application.)
An immunization record alone is not considered a medical record for purposes of establishing U.S. citizenship.
E. Written Affidavits of Citizenship
F. Declarations should only be used in rare circumstances. If the documentation requirement needs to be met through affidavits, the following rules apply:
1. There must be at least two affidavits by two people who have personal knowledge of the event(s) establishing the individual’s claim of citizenship (the two affidavits could be combined in a joint declaration).
2. At least one of the people making the affidavit cannot be related to the applicant or recipient. Neither of the two individuals can be the applicant or recipient.
3. In order for the affidavits to be acceptable, the people making them must be able to provide proof of their own citizenship and identity.
4. If the people making the affidavits have information that explains why documentary evidence establishing the individual’s claim of citizenship does not exist or cannot be readily obtained, the declaration should contain this information as well.
5. The applicant or recipient or other knowledgeable person (guardian or representative) must also provide an affidavit explaining why the evidence does not exist or cannot be obtained.
6. The affidavits must be signed under penalty of perjury.
VI. Evidence of Identity
The following documents, even if expired, may be accepted as proof of identity and must be submitted when the person uses, as proof of citizenship, the documents listed in Paragraphs II through V of this section. (A separate document proving identity need not be submitted when the person submits primary evidence of citizenship and identity as outlined in Paragraph II of this section):
A. A driver’s license issued by a U.S. state or territory. The license must either have a photograph of the individual or other identifying information such as name, age, sex, race, height, weight, or eye color.
B. School identification card. The card must have a photograph of the individual.
C. U.S. military card or draft record.
D. Identification card issued by the federal, state, or local government. The card must have the same information that is required for driver’s licenses.
E. Military dependent’s identification card.
F. Native American tribal document.
G. U.S. Coast Guard Merchant Mariner card.
H. Certificate of Degree of Indian Blood, or another U.S. American Indian/Alaska Native Tribal document. The document must have a photograph or other personal identifying information relating to the individual.
A voter’s registration card does not meet this requirement, as the Centers for Medicare and Medicaid Services (CMS) does not view this as a reliable form of identification.
I. In the absence of the documents described in Section 3.2(VI)(A) through (H) of this part, three or more corroborating documents such as marriage licenses, divorce decrees, high school and college diplomas from accredited institutions, including general education and high school equivalency diplomas, property deeds or titles, and employer ID cards can be used to verify the identity of an individual.
If the individual submitted fourth level verification of citizenship, Section 3.2(VI)(I) does not apply.
VII. Special Identity Rules for Children and Certain Individuals with Disabilities
An individual with a disability in a residential care or institutional facility may have their identity attested to by the facility director or administrator when the individual does not have or cannot get any document on the preceding lists. The affidavit is signed under the penalty of perjury but need not be notarized.
Children under age 16 may have their identity documented using one of the following if none of the documents in Paragraph VI are available:
A. School record including report card, daycare or nursery school record, verified by the Department with the issuing school.
B. Clinic, doctor or hospital record.
C. An affidavit of identity. An affidavit of identity is only acceptable if it is signed under penalty of perjury by a parent, guardian, or caretaker relative stating the date and place of the birth of the child and cannot be used if affidavits were used to establish citizenship.
Identity affidavits may be used for children under age 18 in limited circumstances, when the child is from an area where a school ID with picture is not provided or a driver’s license with a picture is not available.
VIII. Documentary Evidence
Electronic data matching is the primary method of verifying citizenship and identity. If citizenship cannot be verified electronically, the applicant must provide documentary evidence of their citizenship as listed in Paragraph II through VII of this section.
A. All documents must be either originals or copies certified by the issuing agency.
B. Copies of citizenship and identification documents shall be maintained in the case record or electronic data base.
C. Individuals may submit documentary evidence without appearing in person at an OFI office. Documents may be tendered in person, by mail, or by a guardian or authorized
representative. Originals or certified copies presented by the applicant or recipient will be returned.
D. Presentation of documentary evidence of citizenship is a one-time activity; once a person's citizenship is documented and recorded in a state database, subsequent changes in eligibility should not require repeating the documentation of citizenship unless later evidence raises a question of the person’s citizenship.
E. The requirement to provide documentary evidence is the responsibility of the applicant. If documentation is not presented at application, the individual will be given a reasonable opportunity to provide the documentation.
Section 3.3 Documentation and Verification for Noncitizens
An individual who is not a citizen or national of the United States must present alien registration documentation, other proof of immigration registration from the U.S. Citizenship and Immigration Services (USCIS), or other documents indicating the individual's qualifying noncitizen status. If the individual declares a satisfactory noncitizen status and documentation is not presented at application, the individual will be given a reasonable opportunity to provide the documentation. See Part 2, Section 3.1(III). Following the reasonable opportunity period, Temporary MaineCare coverage, as described in Section 12.3 of this part, will not be provided if the applicant cannot provide satisfactory documentation of noncitizen status.
The Systematic Alien Verification for Entitlements Program (SAVE) is the USCIS operative system for verification of noncitizen status for individuals applying for MaineCare. The noncitizen status of applicants who declare a qualifying noncitizen status must be verified through SAVE. If electronic verification indicates that additional documentation is required to verify attested noncitizen status, the Department will request further information from the individual. If an applicant disputes the USCIS response, they may submit additional documentation. The Department will submit additional documentation received by the Department to SAVE to reattempt electronic verification of attested status.
Section 3.4 MaineCare Coverage for Noncitizens
The Personal Responsibility and Work Opportunity and Reconciliation Act of 1996 (PRWORA), P.L. 104-193, describes noncitizens as either qualified or non-qualified aliens. PRWORA further defines aliens who are eligible to receive either full benefit Medicaid or emergency services only, and qualified aliens who are subject to the five-year bar from Medicaid eligibility.
An individual must provide documentation from the United States Citizen and Immigration Services (USCIS) to prove their noncitizen status.
If an individual admits to being an undocumented noncitizen, this information will not be shared with USCIS. All information is held confidential in accordance with Part 1, Section 2.
I. Noncitizens Eligible for Full Benefits
Below is a listing of noncitizen groups who may be eligible for full benefits. See Section 3.4(II) of this part for a listing of noncitizen statuses that are only eligible for Emergency Services.
A. Veteran or Active Duty Personnel
1. Lawfully residing in U.S.; and
2. A veteran of the U.S. Armed Forces with an honorable discharge or on active duty (not training) in the U.S. Armed Forces; or
3. Lawfully residing in the U.S. and a spouse or unmarried child of the veteran described in Paragraph I(A)(1) and (2) of this section. “Unmarried child” means a child is or could be claimed as dependent on veteran’s tax return and meets MaineCare requirements for a dependent child.
B. Legal Permanent Resident
1. Legal permanent resident status (LPR) granted under Immigration and Nationality Act (INA).
i. EXCEPTION: Legal permanent residents are not eligible for full benefits if they have been in the U.S. less than five years. There is no five-year waiting period if any of the following conditions applies:
a. The individual’s date of entry to the U.S. is prior to August 22, 1996;
b. The individual is a child under the age of 21;
c. The individual is pregnant;
d. Prior to adjustment to legal resident status regardless of the LPR status-granted date, the noncitizen’s status was Refugee (C, below), Asylee (D, below), Person whose deportation was withheld (E, below), Amerasian immigrant (J, below) , or Cuban or Haitian entrant (K, below). This noncitizen is eligible as a Refugee, Asylee, Deportee, Amerasian immigrant, or Cuban / Haitian entrant (per Medicaid State Plan).
C. Refugee
1. Refugee status granted under §207 of the INA
D. Asylee
1. Asylee status granted under §208 of the INA
E. Deportation Withheld
1. Deportee status granted under §243(h) of the INA as in effect prior to April 1, 1997; or §241(b)(3) of the INA, as amended
F. Parolee
1. Parolee status granted for at least a year under §212(d)(5) of the INA.
i. EXCEPTION: Parolees are not eligible for full benefits if they have been in the U.S. less than five years. There is no five-year waiting period if any of the following conditions applies:
a. The individual’s date of entry to the U.S. is prior to August 22, 1996;
b. The individual is a child under the age of 21;
c. The individual is pregnant.
G. Conditional Entrant
1. Conditional entrant status granted under §203(a)(7) of the INA in effect before April 1, 1980
i. EXCEPTION: Conditional entrants are not eligible for full benefits if they have been in the U.S. less than five years. There is no five-year waiting period if any of the following conditions applies:
a. The individual’s date of entry to the U.S. is prior to August 22, 1996;
b. The individual is a child under the age of 21;
c The individual is pregnant.
H. Battered Noncitizen or Battered Noncitizen’s Minor Child
1. While lawfully residing in the U.S. the noncitizen or the minor child was battered or subjected to extreme cruelty by a spouse, a parent, or a member of the spouse’s or parent’s family residing in the same household as the noncitizen; and
2. Batterer(s) no longer lives in same household, and
3. The noncitizen or the minor child meets the conditions set forth in §431(c) of PRWORA as amended (Section 431(c) of PRWORA, as amended, is codified at 8 USC 1641(c)).
i. EXCEPTION: Battered Noncitizens are not eligible for full benefits if they have been in the U.S. less than five years. There is no five-year waiting period if one of the following conditions applies:
a. The individual’s date of entry to the U.S. is prior to August 22, 1996;
b. The individual is a child under the age of 21;
c The individual is pregnant.
I. Trafficking Victim
1. Noncitizens certified as a trafficking victim (TV) under 107(b)(1) of the TV Protection Act of 2000, P.L. 106-386.
J. Amerasian
1. Admitted to the U.S. pursuant to §584 of the Foreign Operations, Export Financing, and Related Programs Appropriations Act, 1988
K. Cuban or Haitian Entrant
1. As defined in §501(e) of the Refugee Education Assistance Act of 1980
L. American Indian Born in Canada
1. The individual is at least one-half American Indian blood and provisions of §289 of the INA apply
M. Native American who is a Member of a Federally-Recognized Indian Tribe
1. Member of an Indian tribe under Section 4(e) of the Indian Self-Determination and Education Assistance Act
N. Iraqi Special Immigrant Eligibility Under Public Law 110-161 and 110-181, Section 1244
1. Has same status as refugee under 2009 Department of Defense Bill.
O. Afghani Special Immigrant Eligible Under Public Law 110-161
1. Has same status as refugee under 2009 Department of Defense Bill.
P. Compact of Free Association (COFA) Migrants
1. Effective December 27, 2020 individual citizens from the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau.
Q. Lawfully Residing Pregnant Women, and Children Under the Age of 21
1. Under the Children’s Health Insurance Program Reauthorization Act of 2009, Section 214, lawfully residing pregnant women and children under the age of 21 include:
i. A “Qualified alien” otherwise subject to the five-year waiting period per Section 403 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996;
ii. A citizen of a Compact of Free Association State (i.e., Federated States of Micronesia, Republic of the Marshall Islands, and the Republic of Palau) who has been admitted to the U.S. as a non-immigrant and is permitted by the Department of Homeland Security to reside permanently or indefinitely in the U.S.;
iii. An individual described in 8 C.F.R. § 103.12(a)(4) who does not have a permanent residence in the country of their nationality and is in a status that permits the individual to remain in the U.S. for an indefinite period of time, pending adjustment of status. These individuals include:
a. An individual currently in temporary resident status as an Amnesty beneficiary pursuant to Section 210 or 245A of the Immigration and Nationality Act (INA);
b. An individual currently under protected Status pursuant to Section 244 of the INA;
c. A family Unity beneficiary pursuant to Section 301 of Public Law 101-649 as amended by, as well as pursuant to, Section 1504 of Public Law 106-554;
d. An individual currently under Deferred Enforced Departure pursuant to a decision made by the President; and
e. An individual who is the spouse or child of a U.S. citizen whose visa petition has been approved and who has a pending application for adjustment of status; and
iv. An individual in non-immigrant classifications under the INA who is remaining in the U.S. for an indefinite period, including the following as specified in Section 101(a)(15) of the INA:
a. A parent or child of an individual with special immigrant status under Section 101(a)(27) of the INA, as permitted under Section 101(a)(15)(N) of the INA;
b. A Fiancé of a citizen, as permitted under Section 101(a)(15)(K) of the INA;
c. A religious worker under Section 101(a)(15)(R);
d. An individual assisting the Department of Justice in a criminal investigation, as permitted under Section 101(a)(15)(S) of the INA;
e. A battered alien under Section 101(a)(15)(U) (see also Section 431 as amended by PRWORA); and
f. An individual with a petition pending for 3 years or more, as permitted under Section 101(a)(15)(V) of the INA.
II. Noncitizens Eligible for Emergency Services
A noncitizen who does not declare a qualified noncitizen status from Paragraph I of this section, or has no USCIS documents regarding their noncitizen status, or who is an ineligible noncitizen as defined in Subparagraph B below, or who is a qualified alien subject to the five-year waiting period for full Medicaid can get Medicaid or CHIP Emergency Services only. Individuals must still meet financial requirements and be in a coverable group. These individuals must meet all basic eligibility requirements (including Maine residency) except for citizenship or noncitizen status and providing a Social Security number. If these individuals intend to remain in Maine at the time of application, they will be considered Maine residents.
MaineCare Emergency Services coverage is only available for the noncitizen groups listed below:
A. Undocumented Noncitizen
1. Non-qualified noncitizens who do not have USCIS documentation of their citizenship status.
EXCEPTION: Individuals under the age of 21 described in Part 3, Section 2.1(V) and pregnant individuals described in Part 3, Section 2.3 (III) may be eligible for full MaineCare benefits.
B. Ineligible Noncitizen
1. Non-qualified noncitizens legally admitted on a temporary basis or for a specific time period. The following are examples of individuals who are ineligible noncitizens:
Except for (x) below, these noncitizens should have one of the following types of INS documents: Form I-94, Arrival-Departure Record; Form I-185, Canadian Border Crossing Card; Form I-186, Mexican Border Crossing Card; Form SW-434, Mexican Border Visitor's Permit; Form I-95A, Crewman's Landing Permit; or Form I-184, Crewman's Landing Permit and Identification Card.
i. Foreign government representatives on official business and their families and employees;
ii. Visitors for business or pleasure, including exchange visitors;
iii. Aliens in travel status while traveling directly through the United States;
iv. Crewmen on shore leave;
v. Treaty traders and investors and their families;
vi. Foreign students;
vii. International organization personnel and their families and servants;
viii. Temporary workers, including agricultural contract workers;
ix. Members of foreign press, radio, film or other information media and their families
x. Parolee in the U.S. under Section 212(d)(5) for less than one year
2. EXCEPTION: Some ineligible noncitizens may be included for full coverage under CHIPRA 2009, Section 214. Lawfully residing pregnant individuals and children under age 21 may be eligible for full benefits—refer to Paragraph I(Q) of this section, “Noncitizens Eligible for Full Benefits.” The term “lawfully residing” includes nonqualified noncitizens who are in the U.S. lawfully.
C. Qualified Alien Subject to the Five-Year Waiting Period
1. Qualified aliens who enter the United States on or after August 22, 1996 are subject to a five-year waiting period for full Medicaid unless they are specifically exempt from this waiting period or otherwise included in the State Medicaid Plan.
2. As indicated in Section 3.4 (I), the following qualified aliens are not subject to the five-year waiting period:
i. Qualified Aliens who came to the United States before August 22, 1996
ii. Legal Permanent Residents whose prior qualified alien status was Refugee, Asylee, Person whose deportation was withheld, Amerasian immigrant, Haitian entrant, or Cuban entrant.
iii. Pregnant individuals
iv. Children under the age of 21
v. The following Qualified Aliens:
a. Veteran or Active Duty Personnel
b. Refugee
c. Asylee
d. Deportation Withheld
e. Trafficking Victims
f. Amerasians
g. Cuban and Haitian Entrants
h. American Indian born in Canada
i. Native Americans who are members of Federally-recognized Indian Tribes
j. Iraqi Special Immigrants
k. Afghani Special Immigrants
3. Immigrants who entered the United States prior to August 22, 1996 and did not remain “continuously present” in the U.S. until becoming a qualified alien on or after that date are also subject to the five-year waiting period. Any single absence of more than 30 consecutive days or a combined total absence of 90 days before obtaining qualified alien status interrupts “continuous presence.”
4. The five-year waiting period begins on the date the immigrant obtains qualified alien status. Once the five-year waiting period expires, the qualified alien is eligible for full Medicaid benefits.
Each individual must be a resident of Maine. A resident is an individual living in the State of Maine with the intent to remain indefinitely.
An individual who is in Maine temporarily (e.g., visitor, tourist, or student) is not a resident. The individual should apply to their actual state of residence for Medicaid.
If the individual is living in Maine and has entered the State with a job commitment or seeking a job (even if only a temporary job, e.g., migrant workers), the individual is a Maine resident.
When two or more states cannot resolve which state is the state of residence, the state where the individual is physically located is the state of residence for Medicaid purposes.
Eligibility cannot be denied or terminated because:
I. An individual has not resided in the State for a specified period;
II. The individual did not establish residence before entering a medical institution; or
III. An individual is temporarily or involuntarily absent from the State, provided the individual intends to return once the purpose of the absence has been accomplished, unless another state has determined the individual is a resident there.
IV. An individual does not have a fixed address (e.g., individual is homeless).
Eligible individuals who move out of Maine, intend to remain out of state, and are applying for Medicaid in that state, remain eligible until the other state determines eligibility.
Section 4.1: Children
For purposes of residency a child is any individual under the age of 21. A dependent child is a resident of the state where the parent/caretaker relative resides. An independent child is a resident of the state where they reside with an intent to remain indefinitely.
An individual under age 21 who is a full-time student in the State of Maine will not be considered a resident of Maine if each of the following conditions exist:
I. Neither of the individual's parents reside in the State of Maine;
II. The individual is claimed as a tax dependent by someone who resides in a state other than Maine; and
III. The individual is applying for coverage on their own behalf.
Section 4.2: Title IV-E of the Social Security Act
In any situation where a child is eligible for a Title IV-E payment (including the Federal Adoption Assistance Program) from another state, Medicaid determines the state in which the child is physically living as the state of residency (See Part 3, Section 3.). Children who are receiving services under the Interstate Compact for the Placement of Children (ICPC) and who are not receiving Title IV-E payments from another state are not considered residents of the State of Maine.
Section 4.3: Residents of Medical Institutions
I. If a state arranges for an individual to be placed in an institution located in another state, the state making the placement is the individual's state of residence, regardless of the individual's indicated intent or ability to indicate intent.
II. For any institutionalized individual who became incapable of indicating intent before age 21, the state of residence is that of the individual's parents, or legal guardian. If the parents reside in separate states and there is no appointed legal guardian, the state of residence is that of the parent applying for Medicaid on the individual's behalf.
III. For an institutionalized individual who became incapable of indicating intent on or after age 21, the state of residence is the state in which the individual was living when the individual became incapable of indicating intent.
IV. The state where the institution is located is the individual's state of residence unless that state determines that the individual is a resident of another state by applying the rules under Paragraph I or II of this section.
V. For any other institutionalized individual, age 21 or over, the state of residence is the state where the individual is living with the intention to remain for an indefinite period of time.
Section 4.4: SSI and State Supplement Recipients
An individual who is receiving SSI or State Supplemental payments is considered a resident of the state making the payment.
Section 4.5: Ability to Indicate Intent
An individual is considered incapable of indicating intent if:
I. The individual has an I.Q. of 49 or less, or has a mental age of seven or less based on tests acceptable to the Office of Aging and Disability Services (OADS);
II. The individual has been judged legally incompetent; or
III. Medical or other acceptable documentation supports a finding that the individual is incapable of indicating intent.
All individuals applying for Medicaid coverage are required to have a Social Security number or proof of having applied for one, except:
I. Undocumented noncitizens;
II. Individuals with a religious exemption; or
III. A child who is born to a mother covered by Medicaid at the time of their birth. By the time the child turns one a Social Security number or proof of having applied for one, must be provided.
All individuals applying for Medicaid coverage are asked to provide their Social Security number at the time of application.
Except as noted in Paragraphs I-III of this section, an applicant seeking benefits is required to furnish the Department with a Social Security number. If the applicant has a Social Security number but is unable to provide it, the Department must contact the Social Security Administration to obtain the number.
The applicant is required to apply to the Social Security Administration for a Social Security number if they do not have one. The Department must assist the individual in obtaining verification necessary to apply for a Social Security number. This includes obtaining documents to prove date of birth, citizenship, or identity if these materials cannot be provided by the individual. The Department cannot pay any costs incurred in obtaining this information. The applicant or recipient must provide the Department with verification that the application for a Social Security number has been made. The Social Security number will be provided by the Social Security Administration.
For a child born to a mother not covered by Medicaid at the time of the child’s birth, the Social Security number requirement must be met by the first day of the second month following the month in which the child's mother is discharged from the hospital.
Examples
1. A child is born on July 3. Mother leaves the hospital on July 6. Application for a Social Security number for the child must be completed by September 1.
2. A child is born on July 31. Mother leaves the hospital on August 2. Application for a Social Security number for the child must be completed by October 1.
MaineCare will not be withheld or terminated for lack of a Social Security number if an individual provides verification of application for a Social Security number for those requesting assistance. MaineCare will not be withheld or terminated while verification of the individual's Social Security number is being obtained from the Social Security Administration.
Section 5.1: Social Security Non-Compliance and Sanctions
For any individual who fails to provide, or apply, for a Social Security number as required, Medicaid and/or CHIP must be denied or terminated.
When the Social Security number requirements for a dependent child are not met, the parent/caretaker relative as well as the child must be denied or terminated for Medicaid and/or CHIP.
I. When an individual is not eligible for MaineCare due to non-compliance, the individual is counted in the assistance unit and the individual’s income and assets (when applicable) are used to determine eligibility for other members within the assistance unit.
II. SSI-Related only - When a stepparent must be sanctioned for non-compliance, the stepparent’s income will be considered as if the stepparent chose to be excluded from the assistance unit. The assets owned solely by the stepparent are not considered available to the assistance unit. The stepparent is not considered a member of the assistance unit when determining eligibility under the appropriate Federal Poverty Levels.
III. SSI-Related only - When a caretaker relative other than a parent or stepparent must be sanctioned for non-compliance, the caretaker relative’s income and assets are considered in the same manner as a sanctioned parent’s income and assets would be considered. However, such a sanctioned caretaker relative may choose to be excluded from the assistance unit.
An individual may request good cause for not providing a Social Security number. See Section 8 of this Part for specific information regarding good cause.
Section 5.2: Retroactive Coverage
If otherwise eligible, retroactive coverage will be granted if the Social Security number requirements are met during the application process. If the Social Security number requirements are not met, but at a later date the individual cooperates with these requirements, the retroactive coverage cannot be granted.
Examples
1. A parent refuses to apply for a Social Security number for a child. The parent and the child are denied coverage. One month later, the parent agrees to comply. The parent and child are eligible, effective the first day of the month in which the application for a Social Security number is made. Retroactive coverage cannot be granted.
2. A parent refuses to apply for a Social Security number. Coverage for the parent only must be denied. A year later, the person reapplies and gives a Social Security number proving application for the number was made six months previously. Eligibility may be authorized with up to three months' retroactive coverage because the applicant complied with the Social Security number requirements prior to the retroactive period.
Individuals must be informed that the Social Security number will be used to administer the MaineCare benefit, including eligibility decisions, and will be used for verification of information such as wages, unemployment benefits and bank accounts.
Certain individuals must assign their rights to payment for medical care from any third party to the Department of Health and Human Services and cooperate in obtaining these medical payments. This is done by a referral to the Third-Party Liability (TPL) Unit.
Section 6.1: Who Must Comply
I. Parents or caretaker relatives applying on behalf of themselves and their children;
II. Individuals age 18 or over who are applying on their own behalf; and
III. Individuals under age 18 who are applying on their own behalf who are married or in the military.
This provision does not apply to individuals who are pregnant, or those receiving only the Medicare Savings Program or one of the State funded benefits listed in Section 1of this part.
Section 6.2: Third-Party Liability Requirements
I. Assign rights to payment for medical care;
II. Cooperate with the TPL Unit in obtaining medical payments; or
III. Relinquish medical payments received directly from a third-party resource that were intended to cover services paid by Medicaid.
IV. Items for prospective, current, and retroactive periods that must be reported include:
A. Any court ordered responsibility to pay medical bills by a parent, unless it can be demonstrated that contact with the parent by the TPL Unit or Division of Support Enforcement and Recovery (DSER) could cause harm;
B. Medical insurance (except Medicare) covering the applicant or recipient. This includes private medical group insurance, TRICARE (formerly CHAMPUS), and supplemental policies such as companion plans from Blue Cross/Blue Shield, major medical, and indemnity insurance. Reporting is required whether the cost of premiums is paid by the individual, employer, or another party;
C. The portion of Worker's Compensation benefits for medical services for which the recipient is applying, receiving, or which terminated during the retroactive eligibility period; and
D. Information regarding settled or pending lawsuits involving personal injury.
Section 6.3: Noncompliance
I. Individuals who fail to comply with assignment of rights to medical payments are not eligible for Medicaid. In cases where Medicaid is open at the time of the failure to comply, Medicaid will be closed. When parents or caretaker relatives are applying on behalf of themselves and their children, the parent or other caretaker relative applying on behalf of the child under age 18 is not eligible. The child remains eligible.
II. When an individual is not eligible for Medicaid due to non-compliance, the individual is counted in the assistance unit size and the individual’s income and assets (when applicable) are used to determine eligibility for the assistance unit.
III. SSI-Related Only – When a stepparent must be sanctioned, the stepparent’s income will be considered as if the stepparent chose to be excluded from the assistance unit. The assets owned solely by the stepparent are not considered available to the assistance unit. The stepparent is not considered a member of the assistance unit when determining eligibility under the appropriate Federal Poverty Level.
IV. SSI-Related Only – When a caretaker relative other than a parent or stepparent must be sanctioned, the specified relative’s income and assets are considered in the same manner as a sanctioned parent’s income and assets are considered. However, such sanctioned caretaker relative may choose to be excluded from the unit.
An individual may request good cause for non-compliance with TPL. See Section 8 of this part for specific information regarding good cause.
Section 7.1: Who Must Comply
Certain individuals must cooperate in obtaining medical benefits from the non-custodial parent of a dependent child (See Part 3) and in establishing paternity. If the individual can show that good cause for not cooperating exists, no referral will be made.
These individuals are parents or caretaker relatives applying on behalf of themselves and their children unless the assistance unit is being covered under Transitional Medicaid.
This provision does not apply to individuals who are pregnant, individuals covered under Transitional Medicaid, individuals enrolled only in the Medicare Savings Program, Maine Rx, DEL, or HIPO. An individual who does not comply with this requirement is not eligible for Medicaid. It is the parent or other specified relative applying on behalf of the child under age 18 who is not eligible, not the child.
Section 7.2: Child Support Requirements
I. Identify and help locate those parents of a dependent child for whom Medicaid is requested.
II. Cooperation includes responding to requests for information from DSER and appearing as a witness at a judicial or other hearing or proceeding.
Section 7.3: Noncompliance
I. If an individual who is required to do so fails to comply with these provisions, Medicaid is denied or terminated.
II. When an individual is not eligible for Medicaid because they do not cooperate with DSER the individual is counted in the assistance unit and the individual’s income and assets (when applicable) are used to determine eligibility for the assistance unit.
III. SSI-Related Only - When a stepparent must be sanctioned, the stepparent’s income will be considered as if the stepparent chose to be excluded from the assistance unit. The assets owned solely by the stepparent are not considered available to the assistance unit. The stepparent is not considered a member of the assistance unit when determining eligibility under the appropriate Federal Poverty Level.
IV. SSI-Related Only - When a specified relative other than a parent or stepparent must be sanctioned, the specified relative’s income and assets (when applicable) are considered in the same manner as a sanctioned parent’s income and assets are considered. However, such a sanctioned caretaker relative may choose to be excluded from the assistance unit.
An individual may request good cause (See Section 8 of this part) for noncompliance with obtaining medical support and establishing paternity.
I. Applicant/Participant Rights
A. Every Medicaid or CHIP applicant or recipient may claim good cause for refusing to cooperate with TPL, medical support, or cooperating with the Department’s establishment of medical support from the non-custodial parent. When the individual claims good cause, sanctions are not implemented unless it is finally determined that good cause does not exist.
B. Applicants receive an explanation of cooperation requirements, sanctions, and the right to claim good cause. The Department may attempt to establish paternity and collect medical support in cases where there is no risk to the individual or children.
C. If good cause is not granted, the individual is given the opportunity to withdraw from the benefit or provide additional information to substantiate the claim. If good cause is granted, no referral is made.
II. Acceptable Reasons for Good Cause
Good cause for not cooperating with TPL, medical support, or establishment of medical support from the non-custodial parent may be claimed by the individual if the individual can demonstrate that—
A. cooperation may reasonably be anticipated to result in physical or emotional harm to the child or physical or emotional harm to the caretaker relative which would hinder the ability to care for the child,
B. legal proceedings for adoption of the child are pending before a court or the individual has been working with a social agency to decide whether to relinquish the child for adoption, or
C. the child was conceived as the result of rape or incest.
III. Verification of Good Cause
Documents from court records, law enforcement agencies, medical sources, social service agencies and any other legal document may be used to substantiate rape, adoption and physical or emotional harm to the child or caretaker relative. If such documents are unavailable, information may be secured from other sources familiar with the claims of the individual. The Department should assist the individual in obtaining the required evidence, but no contact with collateral sources will be made without the individual’s knowledge and consent.
If the individual thinks that attempts to establish paternity or collect support would pose a risk to the individual or children, the individual must provide evidence to substantiate the claim of good cause not to cooperate.
The Department may make contact with the absent parent or putative father only if it is essential to the claim for good cause. The Department shall not make contact until the applicant or recipient has the opportunity to—
A. present additional evidence or information which makes contact with the absent parent or putative father unnecessary;
B. withdraw the application for assistance, or have the case closed; and
C. have the good cause claim denied.
IV. Good Cause Determinations
A. The Department determines whether an applicant’s request for good cause is approved or denied. This decision, and the reason for the decision, are documented by the Department and provided to the individual in writing.
B. If good cause is not granted and the individual continues to refuse to cooperate, sanctions are applied to the individual, and the TPL unit and DSER proceed to establish medical support from the non-custodial parent without the individual’s cooperation.
I. Inmates of state prisons, Long Creek Youth Development Center, and local or county jails are eligible for Medicaid coverage as set forth in 10-144 C.M.R. Ch. 101, Ch. I, Section 1 (1.04-B) if they meet the financial and non-financial criteria applicable to non-inmates.
II. Individuals admitted to a medical institution classified as an IMD (Institution for Mental Disease) for over 30 days. Examples of Institutions for Mental Disease are Spring Harbor, Acadia, Riverview Psychiatric Center, and the Dorothea Dix Psychiatric Center. The following applies:
A. If over age 20 and under age 65, these individuals are not Medicaid eligible until they are released, conditionally or unconditionally, or are on convalescent leave from the facility. Individuals may apply prior to discharge.
B. If under age 21 (through age 20) or age 65 or over, coverage is available for all Medicaid coverable services.
I. Individuals who apply for Medicaid and DEL and who are eligible for Medicare Parts A, B and/or D must be enrolled in or apply for these programs and a Medicare Part D Prescription Drug Plan, through the Social Security Administration, at the next available opportunity to do so.
II. Individuals who are enrolled in Medicaid and DEL and subsequently become eligible for Medicare Parts A, B and/or D must be enrolled in or apply for these programs and a Medicare Part D Prescription Drug Plan, through the Social Security Administration, at the next available opportunity to do so.
III. There is good cause for not enrolling in Medicare and/or Medicare Part D Prescription Drug Plan if:
A. The individual is not eligible for Medicaid and DEL to pay any premiums and cost sharing for Medicare Parts A and/or B as described in Part 8.
B. The individual is denied enrollment by Medicare or by a Medicare Prescription Drug Plan due to circumstances beyond their control,
C. The individual has prescription drug coverage which is determined by the insurer to be creditable coverage. Creditable coverage means that the coverage on the average is at least as good as the standard Medicare Prescription drug plan. or
D. Enrollment is not cost effective as determined by the Pharmacy Benefits Manager.
I. An application is a signed request for MaineCare coverage made through one of the following methods:
A. a document approved by OFI as an application form;
B. the My Maine Connection website;
C. the Federally Facilitated Marketplace (FFM) (https://www.healthcare.gov/);
D. The State Based Marketplace (SBM) (https://CoverME.gov); or
E. the telephone or fax machine
II. The individual or someone acting on the individual’s behalf may sign the application form. The applicant may choose anyone to help in completing the form.
III. The date of application is the date the signed application form is received in any OFI office, the FFM, or the SBM. For presumptive eligibility, the date the form is signed and dated by both the applicant and the designated person at specified provider sites is considered the date of application (See Part 9 Section 4(2)(C) and Part 18, Section 4).
IV. All signed applications are acknowledged in writing. A written decision of eligibility is sent to the applicant.
V. A denied application is valid for the month of application and the following month. If new or required information is received to re-evaluate eligibility before the last day of the month following the application month, a new application is not required.
VI. All applicants or re-applicants for MaineCare are given information in writing, or verbally if appropriate, about the following:
A. services covered under MaineCare,
B. conditions of eligibility,
C. the individual's rights, including the right to an Administrative Hearing,
D. responsibilities of recipients, including reporting changes within ten days (See Section 12.2 of this Part), and
E. the 45-day application processing standard (See Section 12.3.1 of this Part).
Section 11.1: Subsequent requests for eligibility
An individual does not need to complete a new application form if:
I. open MaineCare and requesting eligibility for new members orally or in writing. The application date for the new member is the date the request is made. Additional information may still be needed to determine eligibility.
II. open under one MaineCare program (for example Medicaid) and requesting coverage under another MaineCare program (for example Buy-in). In this situation the application date is the date that the request is made, either orally or in writing. Additional information may still be needed to determine eligibility.
III. open MaineCare and now requesting coverage in a facility or Home and Community Based Waiver services. Additional information may still be needed to determine eligibility.
IV. SSI recipients moving to a residential care facility where SSI benefits continue. Additional information may still be needed to determine eligibility.
SSI Individuals who move to a nursing facility need to complete an application. Community coverage is to be kept open while determining eligibility in the facility.
A reapplication is any signed application form received after the notice period (See Section 15 of this Part). This includes review forms returned after that period.
Section 11.2: Recipients of SSI or State Supplement
Individuals and couples who are aged, blind, or have disabilities, who are recipients of SSI or State Supplement are automatically covered as Categorically Needy unless they refuse to assign their rights to payments for medical care. A separate application for Medicaid (including coverage for any Home and Community Based Waiver program) is not needed for these groups.
Section 12.1: Verification of Eligibility Factors
The individual or the individual's authorized representative is responsible for verifying information for all persons in the household whose circumstances affect the eligibility determination. If this information is not provided and cannot be verified electronically by the Department, or electronic verification is inconsistent with the individual’s attestation, the Department will notify the individual or the authorized representative what items require resolution. If, following this notice, verifications are not received, the Department is not able to determine eligibility and a denial or closure notice will be issued. It is the responsibility of the Department to assist the individual in establishing eligibility for MaineCare.
Verification of information needed to determine eligibility must be requested initially from the individual. If information is requested from other sources (with the exception of public records) the individual must be informed. If collateral contacts are necessary to determine eligibility and the individual does not give consent, denial or closure must occur because the Department is unable to determine eligibility.
Section 12.2: Reporting Responsibilities
It is the responsibility of the individual to report changes of income, assets, household composition and any other change in circumstances which affect eligibility for MaineCare. Such change is to be reported within ten days from occurrence. For income purposes, "occurrence" will be considered the date the increased income was received. For all other purposes, "occurrence" will be considered the date the change took place. Applicants and recipients are informed of reporting responsibilities in the notice of eligibility.
Eligibility will be recalculated within 30 days of the receipt of new information which may affect the level of MaineCare coverage or cause ineligibility.
Section 12.3: Temporary Coverage
Temporary Coverage is medical coverage that is authorized because an application has not been processed, by no fault of the applicant or their representative, and an eligibility decision has not been issued, within forty-five days of the application date. As described in Section 3.3 of this part, Temporary Coverage will not be granted following the 90-day reasonable opportunity period.
Section 12.3.1: 45-Day Processing Standard
The applicant must be sent a notice of eligibility no later than 45 days after the date of application. The 45-day processing standard is the result of the settlement of a court case, Polk, et al. v. Longley. The consent decree stated that all applications must be acted upon and a decision made as quickly as possible.
I. Temporary Coverage is authorized when:
A. a decision is not made within 45 days. The Department must authorize temporary coverage. This provides medical coverage from day 46 until a final decision is made on the application.
B. it is necessary to obtain medical reports from physicians, hospitals, or other medical sources and such medical information is not requested from all necessary sources within five days after the date of application. If the reports are not received within 15 days of the first request, a second request must be sent. The applicant is to be notified whenever a second request is made to inform the individual that the necessary medical reports have not been received.
II. Temporary Coverage is not authorized if there is documentation that the applicant or the applicant's source of medical information has not cooperated in obtaining information necessary to make a decision.
Documented non-cooperation by the applicant or the source of the applicant's medical information means that the case record must contain sufficient information to show that the applicant or the source of the applicant's medical information was requested to provide specific information or verification, or carry out particular activities necessary to establish eligibility and that the applicant or medical source failed or delayed in doing so within a reasonable period of time.
Section 12.3.2: Ten Day Processing Standard for Deductibles
The consent decree filed as a result of Polk, et al. v. Longley also mandates that the Department issue a medical card no later than ten days after the applicant furnishes adequate information about incurred medical expenses in order to meet the deductible. See Part 10, Section 6 for information about verification of medical costs.
If the person is not issued a medical card within ten days of submitting the information, temporary coverage is issued, effective on the 11th day unless there is documentation that the individual is not cooperating.
Section 12.3.3: Ending Temporary Coverage
If the individual is found to be eligible, Medicaid coverage will go back to the first month of eligibility. This could be a retroactive month, the month of application or the first day of eligibility.
If the applicant is found ineligible after temporary coverage has been issued, the applicant is sent a notice of denial. There is no advance notice of adverse action (See Section 15 of this Part). The applicant becomes ineligible upon the receipt of the denial notice (five days from the day the notice is mailed).
In no instance may the dates of temporary coverage be eliminated. The individual may request a hearing regarding the denial, but temporary coverage will not continue pending the hearing decision. If the decision of the Hearing Officer is to remand the case back to the regional office for a new decision, temporary coverage is reinstated back to the date that the coverage stopped.
No payment for medical services provided to the individual during the period when the applicant was eligible for temporary coverage is recoverable from the applicant.
An individual's eligibility period is based on the month the application is received. Eligibility for the prospective period is determined for 12 months for all MaineCare programs except for Medically Needy and Maine Rx Plus. Eligibility for Medically Needy is determined for a six-month period. Eligibility for Maine Rx Plus is determined for a 24-month period.
The eligibility period begins on the first day of the application month unless temporary coverage is being given. (See "45-Day Processing Standard", Section 12.3.1 of this Part). In some instances, the individual is not eligible for coverage during the month of application but is eligible for the following month. In this situation, the length of the eligibility period remains the same (6, 12 or 24 months), depending on the type of coverage.
A review is a re-determination of eligibility. Reviews may be completed online through the My Maine Connection website or by using the review form provided by OFI. If the recipient is determined no longer eligible a timely and adequate notice of the adverse action must be sent (See Section 15 of this Part). Recipients are provided at least 30 days from the date of the renewal form to respond and provide any necessary information to determine ongoing eligibility. If the completed review form is not received by the Department by the end of the month in which it is due coverage will end.
If the completed review form and/or required verifications are submitted within 90 days after the date of termination, a new application for MaineCare coverage will not be required. If found eligible, the individual’s coverage will be reinstated back to the date of termination.
Section 13.1: Changes within the Eligibility Period
Changes reported by recipients during the eligibility period must be reviewed to determine the effect of the change on the individual’s eligibility.
If the new information results in a change in the level of coverage, timely and adequate notice of the change of level or termination of benefits must be provided (See Section 15 of this Part.).
Certain categorically eligible individuals have a continuous period of eligibility even if changes occur. These groups are:
Newborns
If the newborn’s mother is receiving Medicaid (or is covered as part of the retroactive period) on the date the baby is born, the baby is eligible regardless of the income of the assistance unit. The mother must be fully covered by Medicaid on the day of the baby’s birth. If mother meets the deductible amount on the day of the baby's birth and is partially responsible for any medical bills on that date, the newborn is not eligible in this group.
Coverage continues for one year without regard to changes in income or other household changes. Coverage under this category ends effective the last day of the month in which the child reaches age one.
II. Children Under Age 19
Any categorically eligible child is continuously eligible for full benefits for 12 months after eligibility is determined by application or review without regard to changes in income or composition of the assistance unit. This provision includes a child on newborn coverage as well as children found eligible for an SSI-Related coverage group even if the SSI or State Supplemental benefits or disability determination end prior to the next MaineCare review. It does not apply to those receiving coverage under Transitional MaineCare. The 12-month period begins with the month of application or review. Eligibility within the 12-month period will end:
A. at the end of the month the child turns 19;
B. if the child ceases to be a state resident; or
C. if mail addressed to the child or child’s household is returned as undeliverable.
III. Pregnant Individual
A. Effective August 1, 2022, pregnant individuals who are found eligible for MaineCare under Part 3, Section 2.3(I) are continuously eligible for 12 months beyond the date the pregnancy ends.
B. Effective December 1, 2023, pregnant individuals who are found eligible for the Children’s Health Insurance Program (CHIP), and enrolled in CHIP while pregnant, under Part 3, Section 2.3(III) are continuously eligible for 12 months beyond the date the pregnancy ends.
Section 13.2: Medically Needy Eligibility Periods
Medically Needy recipients have a six-month eligibility period. Most must meet a deductible to gain eligibility. The only time the six-month deductible period is shortened is in situations when:
I. The individual, age 20, will turn 21 in less than six months;
II. The individual dies;
III. The individual becomes eligible for categorical coverage including coverage in nursing care status; or
IV. The individual voluntarily withdraws from the program. If the individual voluntarily withdraws and reapplies, new deductible periods (both retroactive and prospective) are established based on the new application. Some months of the retroactive coverage period from the first application may not be included in the new retroactive period which is established with the reapplication.
Medically Needy coverage begins on the day of the month that the deductible is met. The individual may have some responsibility for bills for medical services incurred on that day. If there is no deductible or the deductible is met with uncovered medical expenses, coverage begins on the first day of the month of eligibility.
Once the date of eligibility is established, unless there is a change in income which changes the deductible amount, or the individual becomes ineligible for Medicaid, coverage continues to the end of the deductible period. These individuals are entitled to review and timely and adequate notice as described in Section 13 of this part.
Although individuals who are eligible for Medically Needy coverage are in a deductible for six months, if their income is stable and is between the Categorically Needy income levels and the Protected Income Level (PIL) – (See Chart 5), a complete review is necessary once every 12 months rather than once every six months.
Section 13.3: Changes within the Medically Needy Eligibility Period
Changes that impact eligibility are required to be reported and can result in a change in coverage or deductible amount. The Department shall review reported changes to determine the effect on the amount of the deductible or coverage. If the deductible amount or coverage changes, the recipient is provided timely and adequate notice of the change. (See Section 15 of this Part.)
Section 13.4: Retroactive Period
An applicant for Medicaid may receive retroactive coverage of up to three months prior to the application month. The exception to this rule is when the individual is only eligible for the Qualified Medicare Beneficiary (QMB) Buy-In group for the retroactive period.
I. Eligibility for retroactive coverage must be determined separately from prospective coverage. It is possible for an individual to be covered as Medically Needy during the retroactive period and Categorically Needy prospectively or vice versa.
II. The individual must meet basic eligibility requirements for any month during which coverage is received. For example, a person who turned age 65 in the month of application cannot be covered retroactively under an SSI – Related category unless SSI-Related disability criteria are met during the retroactive period. The individual does not have to be eligible in the month of application to be eligible for retroactive coverage.
The entire three-month period may be covered if the individual is eligible for all three months. Medicaid will not cover the third month prior to the application month without including the first and second months unless the individual is ineligible due to basic eligibility requirements or excess assets during the intervening months.
Examples
1. The individual applies in August and has medical expenses incurred in May. There are no medical expenses for June or July. The individual has a deductible of $300 per month.
To cover the expenses incurred in May, the deductible is $900 for three months, not $300 for one month. June and July could be covered with a deductible of $600, or only July could be covered with a deductible of $300. Coverage must be continuously retroactive from the application month.
2. The individual applies in March and incurred medical expenses in December, January and February. They met basic eligibility and asset requirements for December and February, but not January. Expenses incurred in the month of January cannot be covered by Medicaid as the individual was not eligible. The person's deductible for December and February are added together. Expenses incurred in January for which the individual is still responsible can be used as non-covered items toward meeting the deductible. (See Part 10.)
The individual who has a deductible period may withdraw from the program and reapply for retroactive coverage. If an individual voluntarily withdraws, a new prospective period begins with the month of the new application and retroactive eligibility can be determined for up to three months prior to the month of the new application. In determining eligibility for the retroactive period, income received during that period is used.
Individuals who are determined to be eligible for SSI benefits and who indicate on their SSI application that they have medical expenses for the three months prior to their application for SSI do not need to make a separate application for retroactive Medicaid coverage.
If the individual meets the non-financial criteria and the Department has enough information in the case record about the individual's financial situation to determine eligibility for the retroactive period, the individual will be sent a notice of eligibility for MaineCare. If there is not enough information in the case record, or no case record exists, the Department will contact the individual in writing to request verification of specific information.
Individuals who are determined to be eligible for SSI and who indicate on the application for SSI that they do not have medical expenses for the three months prior to their application for SSI will be sent a notice of denial for the three-month period.
Before MaineCare coverage is ended or denied, it must be determined that the individual is not eligible under any coverage group. This includes:
I. Doing a disability determination when there is information that the individual can potentially meet the disability criteria;
II. Determining medical and financial eligibility for a Waiver, Nursing Home Care, or Katie Beckett coverage groups when there is information that the individual can potentially meet these criteria;
III. Determining continuing coverage when SSI/State Supplement cash benefits end;
IV. Determining eligibility under CHIP and Maine Rx.
When individuals lose eligibility for SSI and/or State Supplement payments and a review for continued MaineCare is needed, existing information in the case record is used to determine continuing eligibility for MaineCare. If there is insufficient information in the case record to determine eligibility or a disability determination is necessary, coverage must be continued until ineligibility is determined. If a review form is necessary, it must be sent to the individual within ten days of the date SSI and/or State Supplement coverage has ended.
Individuals are notified in writing as soon as eligibility is determined. If some of the individuals applying for MaineCare are eligible and some are not, the notice must specify who is and who is not eligible and the reasons for each individual's ineligibility.
I. Individuals whose eligibility begins after the month of application must be sent a denial notice for the month(s) of ineligibility.
II. All individuals who apply for Medicaid must be notified of their eligibility for retroactive coverage. Such notification must indicate the months of eligibility or ineligibility.
III. When an individual is determined to be ineligible, the notification contains—
A. a statement that the application has been denied,
B. the specific reason(s) for the denial,
C. the manual citations which support the decisions, and
D. an explanation of the individual's right to request a hearing.
IV. In situations when the intended action is to discontinue eligibility or to reduce services, timely and adequate notice must be given to the recipient.
A. “Timely” means that the notice must be mailed 15 days before the intended change would be effective (ten days for notice plus five days for mail).
Timely actions resulting from computer matching mass changes, such as annual cost of living adjustments to Social Security and other Federal benefit updates require an advance notice of 30 days prior to the effective date of the action.
The only situations in which the timely notice guarantee is not required are as follows:
1. Factual information is received confirming the death of the recipient;
2. A written statement that assistance is no longer wanted is received by the Department. Such statement must be signed by the recipient or the recipient's representative;
3. The recipient has been committed to a public institution (See Section 9 of this Part.);
4. The recipient's cost of care changes (See Part 12, Sections 4.3.4; Part 13, Section 6; and Part 14, Section 6.2.);
5. The recipient's whereabouts are unknown and Departmental mail directed to the recipient has been returned;
6. An applicant for MaineCare has been covered temporarily due to the Department's failure to determine eligibility within the 45-day time limit and is later found to be ineligible; or
7. Documentation is obtained that the individual is currently receiving Medicaid in another state.
B. “Adequate” means a written notice which includes a statement of—
1. the action the Department intends to take;
2. the reasons for the intended action;
3. the regulations supporting such action;
4. an explanation of the rights to request a hearing; and
5. a statement explaining that if a hearing is requested within the notice period, the intended action will not become effective until after a hearing Decision is rendered.
An unfunded or bounced check is considered non-payment of a premium. Upon notice from State Treasury that a check has bounced, the household will be sent a notice of non-payment including the amount now due. If no payment is received within 30 days of the first notice, a second notice is sent. If no payment is received, the penalty will take effect the month following the month in which the second notice is sent, if the client has received 15 days advance notice.
Example
The family is sent a second notice of non-payment on May 10. No payment is received within fifteen days. The penalty starts June 1. If the notice was not sent until May 30, the penalty would take effect July 1.
The penalty is a period of time that the client cannot get coverage under the option for which there is a non-payment. The duration of the penalty period depends on the coverage option involved.
For Working Disabled, coverage cannot continue after the end of the current or last enrollment period unless the unpaid premiums are paid.
For the Special Benefit Waiver, coverage cannot continue after the end of the current period unless all outstanding premiums are paid.
For Katie Beckett, coverage cannot continue after the end of the current three-month premium period unless all outstanding premiums are paid.
Note: A family’s three-month enrollment period cannot be ended to impose this penalty.
DEPENDENT CHILD: A dependent child means a child who is under the age of 18 or is age 18 and a full-time student in secondary school (or equivalent vocational or technical training), if before attaining age 19 the child may reasonably be expected to complete such school or training.
FEDERAL POVERTY LEVEL (FPL): A measure of income issued annually by the Department of Health and Human Services (HHS) that is used to determine financial eligibility for programs and benefits. The poverty guidelines are updated periodically in the Federal Register by the U.S. Department of Health and Human Services under the authority of 42 U.S.C. § 9902(2).
To be eligible for MaineCare in a coverage group for which MAGI-based methodology applies, an individual must:
I. Be a covered individual;
II. Have an eligibility group;
III. Meet basic eligibility criteria in this Part and in Parts 2 and 17; and
IV. Meet income criteria.
To get Medicaid coverage under an eligibility group for which MAGI-based methodology applies, an individual must meet the criteria of at least one of the groups listed in Sections 2.1-2.4 of this part. An individual may meet the criteria of more than one group at the same time in which case they should be enrolled with the group which is the easiest way for them to get the best coverage.
Section 2.1: Children
I. Newborns
A. If the newborn’s mother is receiving Medicaid (or is covered as part of the retroactive period) on the date the baby is born, the baby is eligible regardless of the income of the household. The mother must be fully covered by Medicaid on the day of the baby’s birth. If the mother meets the deductible amount on the day of the baby's birth and is partially responsible for any medical bills on that date, the newborn is not eligible in this group.
B. Coverage continues for one year. This means that the baby is eligible without regard to changes in income or composition of the household.
II. Other Children Under Age One
A. Individuals under the age of one who are living with a parent/caretaker relative or with unrelated others are eligible if they meet other applicable eligibility rules in Parts 2 and 17.
B. Countable income must be equal to or less than the applicable standard in Part 4. Types of countable income are described in Part 17.
C. If the individual is receiving inpatient hospital services on the last day of the month in which the first birthday occurs, eligibility continues until the last day of the in-patient stay if the individual continues to meet all other eligibility criteria.
III. Age 1 through Age 18
A. Individuals age one up to and including age 18 (under age 19) who are living with a parent/caretaker relative or who are living alone or with unrelated others are eligible for Medicaid if they meet other applicable eligibility rules in Part 2 and Part 17.
B. Countable income must be equal to or less than the applicable income standard in Part 4. Types of countable income are described in Part 17.
C. If the individual is receiving inpatient hospital services on the last day of the month in which the 19th birthday occurs, eligibility continues until the last day of the inpatient stay if the individual continues to meet all other eligibility criteria.
IV. Age 19 or 20
A. Individuals age 19 or 20 who are living with parent/caretaker relatives or who are living alone or with unrelated others are eligible for Medicaid if they meet other applicable eligibility rules in Part 2 and Part 17.
B. Countable income must be equal to or less than the applicable income standard in Part 4. Types of countable income are described in Part 17.
C. If the individual is receiving inpatient hospital services on the last day of the month in which the 21st birthday occurs, eligibility continues until the last day of the in-patient stay if the individual continues to meet all other eligibility criteria.
V. Coverage for Noncitizens Under Age 21
A. Effective July 1, 2022, individuals under the age of 21 who would be eligible for assistance under federal Medicaid programs listed in Section 2.1(I)-(IV) of this part, but for their noncitizen status are eligible for state-funded medical assistance through MaineCare.
B. Countable income must be equal to or less than the applicable income standard in Part 4. Types of countable income are described in Part 17.
C. If the individual is receiving inpatient hospital services on the last day of the month in which the 21st birthday occurs, eligibility continues until the last day of the in-patient stay if the individual continues to meet all other eligibility criteria.
Section 2.2: Parent/Caretaker Relative
I. A parent/caretaker relative means a relative of a dependent child by blood, adoption or marriage with whom the child is living, who assumes primary responsibility for the child’s care (as may, but is not required to, be indicated by claiming the child as a tax dependent for Federal income tax purposes), and who is one of the following:
A. The child’s father, mother, grandfather, grandmother, brother, sister, stepfather, stepmother, stepbrother, stepsister, uncle, aunt, first cousin, nephew, or niece;
B. The spouse of such parent or relative, even after the marriage is terminated by death or divorce; or
C. Another relative of the child based on blood (including those of half-blood), adoption or marriage.
Countable income must be equal to or less than the applicable income standard in Part 4. Types of countable income are described in Part 17.
II. Maintenance of a Home
The parent/caretaker relative must be living with a dependent child for whom a home is maintained. The child must be under age 18 or is age 18 and expects to graduate from high school prior to their 19th birthday.
The specified relative does not need to have legal custody as a result of court action in order to be considered to be maintaining a home for the child.
If the child lives part of the time with each parent, the parent with whom the child resides over 50% of the time must apply for the child.
If the child lives 50% of the time with each parent, either parent can apply for the child but not both.
If a child is living with their biological parents but the parents are not married, all three have a coverable group and are potentially eligible. Each parent has a coverable group because each is residing with their child under age 18 (or 18 and expects to graduate from high school by age 19).
If the only child is between the ages of 19 and 21, (or is age 18 and does not expect to graduate from high school prior to the 19th birthday), the parent or caretaker relative cannot receive Medicaid coverage unless the parent or caretaker relative is eligible in another category (e.g., a pregnant individual or meets SSI disability criteria).
Examples
A. The household consists of a single mother and her 18 year old son. In June, the boy graduates from high school. The boy may remain eligible for Medicaid since he has a coverable group (under age 21).
The mother is no longer eligible. She has no coverable group since she is not living with a dependent child covered by Medicaid and she is not pregnant and does not meet SSI disability criteria.
B. The household consists of a mother, father, and their 19 year old daughter. The daughter may be eligible, depending on the income requirements of her coverage group; however, the parents cannot be covered as a parent/caretaker relative.
C. The household consists of a mother, father, and 17 year old girl who is a sophomore in high school. On the child's 18th birthday, the parents' coverage is due to end. Discussion with the family prior to terminating the parents' coverage reveals that the mother has a condition which might meet disability criteria under the SSI program. Coverage for the girl continues. Coverage for the father is terminated. Coverage for the mother continues pending a decision from the Medical Review Team on her disability. If she does not meet criteria for SSI - Related disability (see Part 6, Section 4.3), her coverage must also end.
D. An individual, age 20, is the caretaker relative of their 18-year-old sister. When the sister graduates from high school, both can continue to receive Medicaid as both are still eligible for coverage through the infants and children under age 21 group.
III. Physical Separation
A child may be separated physically from their parent/caretaker relative and still be considered to be living with the parent/caretaker relative, provided that the parent/caretaker relative retains full and exclusive responsibility for the supervision and guidance of the child, offers a home during vacations, and any other delegation of authority to another by the parent/caretaker relative is temporary, voluntary, and revocable.
When separation occurs, it is expected that the child or parent/caretaker relative will return home at the completion of the reason for the separation. The following criteria meet the conditions for when a child or parent/caretaker relative is away from the home.
A. To secure education when high school facilities are not maintained in the place of residence or if existing facilities do not meet the child's educational or social needs. In this later instance, the assessment of needs and the development of a responsible plan must be made through the parent/caretaker relative and a recognized social service agency.
B. To secure planned supervised therapy in a private, organized treatment center such as Sweetser Home, when such is necessitated by special needs of a physical or emotional nature.
C. To attend Governor Baxter State School for the Deaf, provided that adequate resource for therapy cannot be found or developed in the child's own community.
D. To attend a vocational or technical school or college or university.
E. For care for a terminal illness which probably will prohibit eventual return to the home, although if possible, the individual would do so.
F. For other purposes, such as visiting or moving to another community and similar situations where temporary separation occurs. In such situations, the separation may not exceed four months, unless the individual can demonstrate that there is a good reason and that the separation will end as soon as possible.
IV. Reunification
MaineCare coverage may continue for parents/caretaker relatives who would otherwise lose eligibility due to a change in household size when their child is removed from the home by Child Protective Services pursuant to state law. Eligibility will continue until the parent is either:
A. No longer participating in the rehabilitation and reunification plan as required by the plan; or
B. Until the parental rights have been terminated.
If the parent/caretaker is no longer eligible for reasons other than the change in household composition (e.g., an income increase, failure to renew, etc.) MaineCare eligibility may end.
Section 2.3: Pregnant Individuals
I. Pregnant individual means an individual during pregnancy and the post-partum period, which begins on the date the pregnancy ends, and extends for 12 months beyond the month in which the pregnancy ends.
Pregnant individuals whose countable income is equal to or below the applicable income standard in Part 4 are eligible. The household size is increased by one (or by two if the individual is expecting twins). Cooperation with Third Party Liability (TPL) and Division of Support Enforcement and Recovery (DSER) is not a factor in determining eligibility.
Retroactive coverage may be granted for up to three months if the individual was pregnant and financially eligible.
If an individual is eligible as a pregnant individual in the month of application, or the retroactive period, or due to a change in ongoing eligibility, they continue to be eligible for 12 months beyond the month in which the pregnancy ends.
Only the pregnant individual is eligible under this coverage group. Other family members must be in another coverable group.
If the individual is receiving inpatient hospital services on the last day of the month in which coverage as a pregnant individual occurs, eligibility continues until the last day of the in-patient stay if the individual continues to meet all other eligibility criteria in Part 2 and Part 17.
II. Presumptive Eligibility for Pregnant Individuals
A pregnant individual is eligible to receive ambulatory prenatal care beginning on the day that a qualified Medicaid provider determines that the pregnant individual's household’s countable MAGI-based income is less than the applicable income standard in Part 4. This coverage is called "presumptive eligibility".
The qualified Medicaid provider will use a presumptive eligibility application to establish the MAGI household size and income for the presumptive determination. The Medicaid provider must contact the Department within five working days after the date the presumptive determination is made to report the name, date of birth, and Social Security number of each individual determined eligible under the presumptive eligibility standards.
Once the Medicaid provider has made a presumptive determination, the individual is eligible through the last day of the month following the month in which a presumptive determination is made. If the individual applies for Medicaid during this presumptive eligibility period, presumptive eligibility ends the day that the Medicaid application is granted or denied. Presumptive eligibility can only be determined once per pregnancy.
Example
A pregnant individual is determined presumptively eligible by the Medicaid provider on September 14. They receive coverage under presumptive eligibility through October 31. On October 31 they file an application for Medicaid. Because they applied for Medicaid within the presumptive eligibility period, the individual continues to be presumptively eligible through the day the application is granted or denied.
The Department is required to provide appropriate notices based on the standard Medicaid application, but is not required to send any notice regarding the discontinuance of the presumptive eligibility period. The individual has no appeal rights for the discontinuance of presumptive eligibility.
It is the responsibility of the Medicaid provider to:
A. provide the applicant with an approved standard MaineCare application form;
B. notify OFI of the presumptive eligibility determination within five working days from the date the determination was made;
C. notify the applicant (in writing and orally if appropriate) that if the applicant does not file a standard MaineCare application with OFI before the last day of the following month, presumptive eligibility coverage will end on that last day;
D. notify the applicant (in writing and orally if appropriate) that if the applicant files a standard MaineCare application with OFI before the last day of the following month, presumptive eligibility coverage will continue until an eligibility determination is made on the application that was filed.
III. Coverage for Pregnant Individuals for the Health of Unborn Children From Conception to End of Pregnancy and 12 Months Postpartum
Effective July 1, 2022, services are available through the Children’s Health Insurance Program (CHIP) to pregnant individuals who are eligible for Medicaid but for noncitizen status. Effective December 1, 2023, if an individual is eligible as a pregnant individual, and enrolled in CHIP while pregnant, eligibility from conception to end of pregnancy extends 12 months beyond the month in which the pregnancy ends, regardless of any subsequent changes in household income.
To be covered in this category the parent of the unborn child must be:
Pregnant
A resident of the State of Maine
Otherwise eligible for federally funded coverage but for citizenship.
Uninsured. Applicants are considered to be uninsured if they do not have credible health insurance that provides coverage of prenatal care services.
Countable income is equal to or less than 208% FPL. Types of countable income are described in Part 17.
Section 2.4: Expansion Adults
Eligibility for this group must meet the qualifications below.
Expansion Adults means an individual between the ages of 19 and 64 who meets the following qualifications:
I. Is not pregnant;
II. Is not entitled to or enrolled for Medicare benefits Part A or Part B; and
III. Is not otherwise eligible for and enrolled in mandatory MaineCare coverage.
For parents and other caretaker relatives living with a dependent child under age 21 who meet the requirements in (I) through (III) of this section and either have income above 100% FPL or don’t meet the requirements for a parent/caretaker under Section 2.2 of this part, the child must receive benefits under Medicaid, CHIP, or otherwise be enrolled in minimum essential coverage as defined in 42 C.F.R. § 435.4 to be eligible as an expansion adult.
Other special coverage groups refers to various special groupings created by federal and/or state legislation. Specifically, IV-E Eligible and State Adoption Assistance:
I. Move-In from Out of State
An individual under the age of 21, who is receiving Title IV-E funds from another state or is covered by a State Adoption Agreement from another state and moves to Maine, is eligible for Medicaid. The income and assets of the child and parents are not considered to determine eligibility for this child.
There must be an assignment of rights to medical support and the Department must be provided with a Social Security number for the child.
There are three groups of children who fall into this category:
A. Children whose medical and financial circumstances qualify them for federal IV-E adoption assistance;
B. Children whose medical and financial circumstances qualify them for federal IV-E foster care assistance; and
C. Children whose medical and financial circumstances qualify them for state adoption assistance.
The foster or adoptive parents in Maine are provided with a written explanation of their status by the state of origin which usually serves as verification of their status.
II. Maine Residents
The following children are eligible for Medicaid:
A. Foster children;
B. Children named in a Federal (IV-E) or Maine State Adoption Assistance Agreement;
C. Children who are placed in Permanency Guardianship by the State of Maine, as defined in 22 M.R.S. § 4038-C.
III. Former Foster Care Children
An individual is eligible to enroll in Medicaid if they:
A. Are under age 26;
B. Are not enrolled in another mandatory Medicaid coverage under 42 C.F.R. §§ 435.110 through 435.118 or 42 C.F.R. §§ 435.120 through 435.145; and
C. Effective January 1, 2023 were in foster care in any state in the United States and were enrolled in Medicaid at age 18. Prior to January 1, 2023 only individuals in foster care in the State of Maine were eligible under this coverage group.
The income and assets of the individual (or anyone else in their household) are not considered to determine eligibility for the individual.
Transitional MaineCare (TM) is MaineCare coverage that is available to families who become ineligible for MAGI-based coverage due to increased earnings or hours of employment of the parent or caretaker relative (as defined by Section 2.2 in this Part), or because of receipt of or increase in alimony.
Section 4.1: General Requirements
Section 4.1.1: Covered Individuals
TM is available to individuals who were eligible for MAGI-based MaineCare coverage in either the Children Under 18, or the Parent/Caretaker groups (except Expansion Adults with income above 100% FPL).
TM households are determined on an individual basis using MAGI household composition rules. Some individuals may be granted TM while others may continue in MAGI coverage groups.
Membership in a TM household includes those individuals whose needs and income were included in determining eligibility for the MAGI coverage group at the time of closing.
The following individuals may also be added to a TM household:
I. a parent/caretaker relative who returns home whose needs and income would be considered in determining coverage under MAGI, and whose earnings/alimony, either alone or added to other income of the household, result in the loss of MAGI coverage;
II. a child or parent/caretaker relative who moves into the home after TM has started;
III. a child who is born after TM has started; or
IV. a pregnant individual who was included in a MAGI household and loses coverage after the end of the pregnancy, if the individual’s spouse and/or dependent children are receiving TM.
Section 4.1.2: Conditions of Eligibility
At least one member must have been eligible for and receiving coverage under an eligibility group for which MAGI-based methodology applies in one of the three months immediately preceding ineligibility. Retroactive coverage under an eligibility group for which MAGI-based methodology applies will be counted for this purpose even if there is only one month of retroactive coverage and no current eligibility under an eligibility group for which MAGI-based methodology applies.
Example
A family applies in July and requests retroactive coverage for one month. The family is covered under an eligibility group for which MAGI-based methodology applies for June (the retroactive month) and is ineligible for coverage in July due to increased earnings. TM eligibility exists starting in July.
An individual is not eligible for TM if:
I. The State makes a finding that, at any time during the last 6 months the individual was ineligible for Medicaid because of fraud; or
II. Information is received which indicates the household was incorrectly determined eligible for MAGI-based coverage.
Individuals receiving TM must continue to assign their rights to payment for medical care from any third party (See Part 2, Section 6). The custodial parent is not required to cooperate in obtaining medical support or payments from the non-custodial parent.
Section 4.2: Eligibility for Transitional Medicaid: Individuals Who Become Ineligible for Coverage under MAGI-Based Coverage Due to Increased Earnings
Section 4.2.1: Computation of Transition Period
Individuals who lose eligibility in a coverage group for which MAGI-based methodology applies due to the earnings of a parent/caretaker relative may remain eligible for Medicaid for up to 12 months. The scope of services will be the same as those provided to those eligible under an eligibility group for which MAGI-based methodology applies.
The 12-month count begins the month after the individual becomes ineligible for MAGI coverage.
Example:
A family reports an increase in the parent’s earnings on April 5. The parent is now ineligible in April. The first month for TM is May.
Section 4.2.2: Termination of TM
TM will be closed with timely and adequate notice when:
I. A child no longer resides within the household. The TM household must include a child who resides in the household. This child must be under the age of 18 or between the ages of 18 and 19, and a student regularly attending a secondary school on a full-time basis (or in the equivalent level of vocational or technical training at the high school level) and reasonably expected to complete the program prior to their 19th birthday.
II. The parent/caretaker relative is no longer employed. Note: good cause reasons will be requested for lack of employment and established by the Department. Some reasons for good cause for lack of employment include but are not limited to:
A. dismissal/termination by the employer;
B. illness of employed individual;
C. care of other ill family members who are residing within the household;
D. loss of transportation;
E. harassment;
F. risk to health and safety;
G. loss of child care if there is not any other adequate replacement; or
H. other reasons which indicate the action was not deliberate or willful.
III. The household moves out of state or the recipient’s whereabouts are unknown and Departmental mail has been returned.
IV. The member becomes eligible in another comparable MaineCare category.
A determination of whether the individual is potentially eligible for any other MaineCare categories must be made prior to the termination of Transitional Medicaid.
In situations when the intended Department action is to terminate coverage, timely and adequate notice must be given to the recipient as described in Part 2, Section 15.
Section 4.2.3: Client Reporting Responsibilities
The family must report when a child no longer resides within its household or when there are any other changes in the family composition. All changes must be reported within the time frames outlined in Part 2, Section 12.2.
Section 4.2.4: Department Notice Requirements
At the time of the closing under MAGI-Based rules, a determination must be made for the individual’s eligibility for Transitional Medicaid and a notice must be sent informing the individual of the following:
I. The individual's eligibility for the extension and a medical card which lists all eligible members; and
II. The conditions under which the initial extension may be terminated.
A review is due in the 12th month. It is used to determine continuing eligibility for MaineCare coverage when TM ends.
Section 4.3: Eligibility for Transitional Medicaid: Individuals Who Become Ineligible for MAGI-Based Coverage Due to Increased Alimony
Transitional Medicaid coverage for persons with increased alimony is limited to 4 months; it continues irrespective of other changes in household income or composition.
Coverage under a MAGI-based eligibility group must have been closed solely because of an increase in the amount of alimony being received by an individual in the household.
The individual must have been eligible under a MAGI-based eligibility group for three of the six months prior to the month they are determined ineligible.
The four-month count for extended Medicaid begins the first month after the individual became ineligible for MAGI coverage.
Example
A client reports in May that their alimony has increased and now the countable income exceeds program standards. The four-month extension begins in June.
At the end of the four-month period, the individual's coverage is to be reviewed for potential future coverage. If eligibility does not exist, coverage is to be ended following timely and adequate notice procedures (Part 2 Section 15).
FAMILY SIZE: Family size means the number of persons counted as members of an individual’s household. In the case of determining the family size of a pregnant individual, the pregnant individual is counted as one individual plus the number of children they are expected to deliver. In the case of determining the family size of other individuals who have a pregnant individual in their household, the pregnant individual is counted as one individual.
FEDERAL POVERTY LEVEL (FPL): A measure of income issued annually by the Department of Health and Human Services (HHS) that is used to determine financial eligibility for programs and benefits. The poverty guidelines are updated periodically in the Federal Register by the U.S. Department of Health and Human Services under the authority of 42 U.S.C. § 9902(2).
HOUSEHOLD INCOME: Household Income means the sum of the MAGI-based income, of every individual included in the individual’s household (subject to the rule described in Section 2(C) below), EXCEPT that income in the following circumstances will not be included in household income: (1) The MAGI-based income of an individual who is included in the household of his or her natural, adopted or step parent, and is not expected to be required to file a tax return under section 6012(a)(1) of the Internal Revenue Code for the taxable year in which eligibility for Medicaid is being determined, whether or not the individual files a tax return; and/or (2) The MAGI based income of a tax dependent who is an individual other than a spouse or a biological, adopted, or step child who expect to be claimed as a tax dependent by another taxpayer, who is not expected to be required to file a tax return under section 6012(a)(1) of the Internal Revenue Code for the taxable year in which eligibility for Medicaid is being determined, whether or not such tax dependent files a tax return.
MAGI-BASED INCOME: MAGI-Based income is as defined in Part 17, Section 2.1.
TAX DEPENDENT: Tax dependent, pursuant to 42 C.F.R. § 435.4, has the same meaning as the term “dependent” under section 152 of the Internal Revenue Code, as an individual for whom another individual claims a deduction for a personal exemption under section 151 of the Internal Revenue Code for a taxable year.
To determine an individual’s eligibility for Medicaid, the following calculation applies:
A. Determine the individual’s Household.
B. Determine the individual’s Household Income.
C. Compare the individual’s Household Income to the Income Standard. If the individual’s Household Income is over the income standards, subtract an amount equal to 5 percentage points of the Federal poverty level for the applicable family size and reassess by comparing the individual’s Household income to the Income Standard.
D. If the individual’s household income is at or below the Income Standard, then the individual is eligible for Medicaid.
For purposes of “Household Income”, household will be defined as follows:
(1) Basic rule for taxpayers not claimed as a tax dependent: If an individual requesting coverage expects to file a tax return for the taxable year in which an eligibility determination or renewal of eligibility is being made, and who does not expect to be claimed as a tax dependent by another taxpayer, the household consists of the taxpayer, the individual’s spouse if living with and/or filing jointly, and any person(s) the taxpayer expects to claim as a tax dependent.
(2) Basic rule for individuals claimed as a tax dependent: If an individual requesting coverage expects to be claimed as a tax dependent for the taxable year in which an eligibility determination or renewal of eligibility is being made (even if he/she also expects to file a tax return), his/her household will consist of the tax filer who expects to claim the individual as a tax dependent, the tax filer’s spouse if living with and/or filing jointly, and any person(s) the tax filer expects to claim as a tax dependent (including the individual) unless the individual meets one of the following exceptions.
(a) The individual expects to be claimed as a tax dependent of someone other than the individual’s spouse or biological, adopted or step parent;
(b) The individual is a child under age 19 living with both parents, but expects to be claimed as a tax dependent by only one parent because the parents don’t file jointly;
(c) The individual is a child under age 19 who expects to be claimed by a non-custodial parent.
(3) Rules for individuals who neither file a tax return nor are claimed as a tax dependent OR who meets one of the exception from Section 3A(2) of this Part: If an individual meets one of the three exceptions listed in Section 3A(2), or if an individual does not expect to be a tax filer for the taxable year in which an eligibility determination or renewal of eligibility is being made and does not expect to be claimed as a tax dependent, his/her household will consist of:
The individual;
The individual’s spouse if living with the individual;
The individual’s natural, adopted and step children under the age of 19 if living with the individual; and/or
(d) If the individual is under the age of 19, the individual’s natural, adopted and step parents and natural, adoptive and step siblings also under age 19 if living with the individual.
The Income Standard for the following groups is as follows:
Parents or caretaker relatives as defined in Part 3, Section 2.2: equal to or less than 100% of the Federal Poverty Level.
Effective October 1, 2023 children age 19 and 20 as defined in Part 3, Section 2.1(IV): equal to or less than 300% of the Federal Poverty Level.
Pregnant individuals as defined in Part 3, Section 2.3: equal to or less than 209% of the Federal Poverty Level.
Effective October 1, 2023 children under age 1 as defined in Part 3, Section 2.1(II): equal to or less than 300% of the Federal Poverty Level.
Effective October 1, 2023 children age 1 up to and including age 18 (under age 19) as defined in Part 3, Section 2.1(III): equal to or less than 300% of the Federal Poverty Level.
Expansion Adults as defined in Part 3, Section 2.4: equal to or less than 133% of the Federal Poverty Level, except for Expansion Parents and Caretaker Relatives eligible under Part 3, Section 2.4, whose income must be between 100% and 133% of the Federal Poverty Level.
Financial eligibility for Medicaid must be based on current monthly household income and family size.
There is no asset limit for any individuals in any of the eligibility groups for which MAGI-based methodology applies.
If an individual is found ineligible through the application of this Part, but his/her household income is below 100% FPL when determined in accordance with 26 C.F.R. § 1.36B-1(e), eligibility will be determined in accordance with the latter.
Under this circumstance, the individual will be asked by OFI to provide documentation to explain the difference between the two determinations. If the documentation provided adequately substantiates the reason for the difference, Medicaid financial eligibility for the individual will be determined in accordance with 26 C.F.R. § 1.36B-1(e).
STATE-BASED MARKETPLACE: The state-based marketplace (SBM) is a website established and operated by Maine’s offical marketplace to facilitate the purchase of health insurance in accordance with the Patient Protection and Affordable Care Act (CoverME.gov).
MYMAINECONNECTION: MyMaineConnection (www.mymaineconnection.gov) is a website administered by the Office for Family Independence in which residents of the State of Maine can apply online for medical coverage.
The Children’s Health Insurance Program (CHIP), formerly known as CubCare in Maine until 2024, is authorized under Title XXI of the Social Security Act. It provides health coverage as an expansion of Medicaid to uninsured children who are under the age of 19 who meet certain other requirements as identified in this section.
Maine also implements a separate CHIP for pregnant individuals for the health of the fetus. See Part 2, Section 2.3 (III) for eligibility requirements.
The Department has the right to collect from other available insurance or from settlement(s) for accidents or injuries whenever the Medical ID was used.
To be eligible for CHIP, individuals must meet the basic eligibility requirements for Medicaid coverage as identified in Part 2.
Children Excluded from Coverage
1. A child who is eligible for coverage under a Medicaid program. This includes Transitional Medicaid (TM).
2. A child age 19 and over.4. A child who is covered under a group health insurance plan through an employer.
3. A child who is covered under health insurance as defined by the Health Insurance Portability and Administrative Act (HIPAA). This includes most insurance plans except for those covering one particular service or illness only, such as insurance for dental care or cancer. This exclusion applies regardless of whether the coverage is provided through an adult who resides with the child or through an adult living in another household.
An application is the request for medical coverage made by signing and dating an approved application form. The individual or anyone acting on the individual’s behalf may sign the application form. The applicant may choose to have another person help them complete the form.
The date of application is the date the signed application form is received in or by any OFI regional office, My Maine Connection, or the State Based Marketplace. My Maine Connection or the State Based Marketplace will forward the application to OFI. Applications must be processed within 45 days of their receipt by the Department. If the applicant is not sent a notice of the eligibility decision within 45 days, temporary coverage will be authorized. (See Part 2 § 12.3.)
All signed applications will be acknowledged in writing. A written eligibility decision will be sent to the applicant.
An application is valid for authorizing coverage starting the month the application is received.
When an individual applies for medical coverage, this is considered to be an application for Medicaid and CHIP.
Verification of information needed to determine eligibility must be requested initially from the individual. If information is requested from other sources (with the exception of public records) the individual must be informed. If the individual does not give consent for other sources to provide the Department with the requested information, denial or termination must occur. (See Part 2 § 12.1.)
When a decision cannot be made due to inconclusive or conflicting information, the individual will be notified what questions remain and what needs to be resolved. If the Department cannot determine that eligibility exists after contacting the individual or collateral contacts, assistance will be denied or terminated.
There is no asset criteria for eligibility under CHIP.
Household income for children, age 0 up to age 19: equal to or less than 300% of the Federal Poverty Level for the family size.
Medicaid rules will be followed as identified in Part 2 and Part 4 to determine the appropriate household and whose income will be budgeted.
Coverage under CHIP is determined for a twelve-month enrollment period for all members of a household, beginning with the month of application or, if ineligible for that month, coverage starts in the following month. There is only one enrollment period for a household.
Eligible children may receive retroactive coverage of up to three months prior to the application month. The rules in Part 2, Section 13.4 apply.
The child remains eligible for the 12-month period without regard to changes in household income.
D. The individual must complete a renewal, and be found eligible, in order for coverage to continue beyond the initial twelve month enrollment period.
The individual will be sent a renewal notice at least 30 days before the 12-month enrollment period ends.
E. A child who has been covered by CHIP and whose household income exceeds 300% of the Federal Poverty Level at the end of the 12-month enrollment period will be provided notice that their application was transferred to the SBM and informed of the option to purchase extended coverage through the Health Insurance Purchase Option (HIPO). Refer to Chapter 335 Health Insurance Purchase Option (HIPO) in this manual. (10-144 C.M.R. Ch. 335)
Eligibility Notices
Individuals will be notified in writing as soon as eligibility is determined. If some of the individuals applying for medical coverage are eligible and some are not, the notice must specify who is or is not eligible and the reasons for each individual's ineligibility.
Individuals whose eligibility begins after the month of application must be sent a denial notice for the month(s) of ineligibility.
When an individual is determined to be ineligible, the notification will contain a statement that the application has been denied, the specific reason(s) for the denial, the manual citations which support the decisions, and an explanation of the individual's right to request a hearing.
Adverse Action Notices
In situations when the intended action is to discontinue eligibility or to reduce services, timely and adequate notice must be given to the recipient. However, coverage will not be continued beyond the enrollment period pending a hearing decision.
"Timely" means that the notice must be mailed 15 days before the intended change would be effective (ten days for notice plus five days for mail).
"Adequate" means a written notice which includes a statement of the action the Department intends to take, the reasons for the intended action, the regulations supporting such action, and an explanation of the rights to request a hearing.
Denials
If an application is denied for MAGI- Related Medicaid or CHIP, notification will be given that other coverage may be available if the household has large medical bills or a child has a disabling condition. The application will be transferred to the SBM.
Closings
Before MaineCare or CHIP coverage is ended or denied, it must be determined that the individual is not eligible under any coverage group.
If coverage under CHIP is ended for a reason other than that the enrollment period has ended, the individual will be given adequate and timely notice.
Rules regarding hearings are identified in Part 1, Section 7.
The Social Security Administration administers the SSI Program which was established to meet the needs of aged, blind or disabled individuals. The basic needs in the SSI Program are established for individuals and couples by the Federal government.
Individuals who receive SSI or State Supplement payments, or are eligible under Section 1619(b) of the Social Security Act do not need to file a separate application for Medicaid. They are automatically eligible for Medicaid unless they refuse to assign their rights to medical payments (see Part 2, Section 6) for medical care or are ineligible due to Medicaid Qualifying Trust rules (see Appendix H). Section 1619(b) individuals are those who are considered disabled but their earned income disqualifies them for an SSI payment. However, due to the use of a higher income guideline by SSI, they continue to be carried as an open SSI case and they are Medicaid eligible.
In general, the criteria in this section follows those used by the Social Security Administration when determining the eligibility for Supplemental Security Income (SSI) for individuals who are aged (at least age 65), blind or disabled. When the SSI office makes an eligibility decision based on disability or blindness the decisions may not be overturned by the Department unless new information is presented, or conditions change. In this case, an independent decision of the individual's or couple's eligibility Medicaid may be made.
If the Department of Health and Human Services has an open Medicaid case in any category, except for temporary coverage, this coverage will continue until a decision is reached on an SSI application or appeal regarding disability or until other Medicaid eligibility criteria are not met. The appeal must be filed in a timely manner according to SSI rules.
An individual who has been determined by the Disability Determination Services (DDS) to meet the disability criteria for receipt of SSI also meets the disability criteria for SSI - Related Medicaid benefits for the three months prior to application for SSI benefits. If there is an indication that the onset of the disability was between the first day of the third prior month and the application date eligibility begins with the first month of disability. Unless there is information to the contrary, the individual's statement of the onset may be accepted. If there is an indication that the individual was not disabled on the first day of the third month prior to the application for SSI, and if there is no information which would indicate the date of the onset of disability, then the procedures outlined in Section 4.3 of this Part must be followed. In determining retroactive Medicaid eligibility for all SSI recipients (aged, blind or disabled) all eligibility factors must be met. The best information available regarding income and assets should be used.
Individuals who are aged, blind or disabled and are not receiving SSI or a State Supplement payment may be eligible for Medicaid as SSI - Related if they meet the basic criteria of the SSI Program below.
Section 4.1: Aged
The individual must be 65 years of age in or before the month in which eligibility begins.
Section 4.2: Blind
The individual must have, in terms of ophthalmic measurement, central visual acuity of 20/200 (can see on the eye examination chart at 20 feet what a normal vision can see at 200 feet) or less in the better eye with best correcting glasses or must have a field defect in which the peripheral field has contracted to such an extent that the widest diameter of visual field subtends at an angular distance of no greater than 20 degrees or must have a visual field efficiency reduced to 20% or less; or if in the opinion of the consulting ophthalmologist the visual field limitation encroach on the central visual axis sufficient to interfere with useful vision. Such a person has what is known as economic blindness which prevents the performance of ordinary activities for which eyesight is essential. For determining the visual field efficiency, the amount of radial contraction in the eight principal meridians shall be determined, and the sum of these eight, divided by 420 (the sum of the eight principal radii of the industrial visual field) multiplied by 100 will give the visual field efficiency of one eye in percentage.
Section 4.3: Disabled
Current eligibility for Social Security, Railroad Retirement, Medicare or SSI benefits based on disability or blindness is proof of disability.
For individuals whose SSI Benefits are terminated, for reasons other than disability, a contact to the local Social Security Office should be made to determine the next disability review date. For Medicaid purposes this review date will be adopted.
If the individual is not currently receiving benefits from one of the sources above, then an independent disability decision must be made. To determine if a person meets the SSI standard of disability, a referral will be made to the Medical Review Team (MRT). This group consists of a physician and a caseworker who specialize in medical eligibility determinations. This group makes the decision as to whether or not the individual meets the SSI standard of disability and establishes any additional reviews of medical disability.
Section 4.3.1: Making the Decision
I. This decision is based on a medical report which must include a substantive diagnosis based either on existing medical evidence or upon current medical examination. To end coverage based on disability, the Medical Review Team must determine that medical improvement as set forth in 20 CFR 416.994 has occurred in relation to the most recent decision that was favorable to the individual.
The medical evidence must be from an acceptable source. Acceptable sources are:
A. licensed physicians;
B. licensed osteopaths;
C. licensed or certified psychologists;
D. licensed optometrists for the measurement of visual acuity and visual fields. (A report from a physician may be required to determine other aspects of eye diseases);
E. a hospital, clinic, sanitarium, medical institution or health care facility; or
F. P.E.T. and other school medical records.
Reports from chiropractors are not acceptable.
II. The social history must contain sufficient information to make it possible to relate the medical findings to the activities of substantial gainful employment and to determine if the individual is disabled.
III. An impairment or combination of impairments is not severe if it does not significantly limit physical or mental ability to do basic work activities.
Basic work activities are the abilities and aptitudes necessary to do most jobs. Examples of these include:
A. physical functions such as walking, standing, sitting, lifting, pushing, pulling, reaching, carrying, or handling;
B. capacities for seeing, hearing and speaking;
C. understanding, carrying out, and remembering simple instruction;
D. use of judgment;
E. responding appropriately to supervision, co-workers and usual work situations; and
F. dealing with changes in a routine work setting.
IV. The following are criteria which the MRT uses to determine if an individual meets the definition of initial disability and any additional reviews for SSI - Related disability coverage:
An individual is determined to be disabled only if the physical or mental impairments have lasted or can be expected to last for a continuous period of not less than twelve months, expected to end in death, or are so severe that the individual is not only unable to do previous work, but cannot (considering age, education and work experience) engage in any kind of Substantial Gainful Activity (SGA) which exists in the community regardless of:
A. whether a specific job vacancy exists; or
B. whether the individual would be hired if application for work were made.
If the individual is not working, disability must be based on activities which still can be performed despite limitations (residual functional capacities). Activities, age, education and work experience will be used when the limitations would not permit the individual to return to prior work in order to determine if the individual can participate in any other type of work.
V. A child is considered disabled if there is any medically determinable physical or mental impairment of comparable severity.
VI. The physical or mental impairment must be one that results from anatomical, physiological, or psychological abnormalities which are demonstrable by medically acceptable clinical and laboratory diagnostic techniques. The individual must follow any prescribed treatment plan.
VII. Coverage may be granted or continued if the individual has good reason for not following a prescribed treatment plan. These reasons include:
A. the specific medical treatment is contrary to the established teaching and tenets of the individual's religion.
B. the prescribed treatment is cataract surgery for one eye but there is an impairment of the other eye resulting in a severe loss of vision which is not subject to improvement through treatment.
C. surgery was previously performed with unsuccessful results and the same surgery is again being recommended for the same impairment.
D. the treatment is very risky, unusual, or of a great magnitude such as open heart surgery or organ transplants.
E. the treatment involves amputation of an extremity or a major part of an extremity.
VIII. A person who otherwise qualifies for medical benefits, by reason of disability, cannot be an eligible individual for any month if determined to be a drug addict or an alcoholic unless undergoing treatment that may be appropriate and available for that condition. If the individual is in an institution it must be approved for this purpose and treatment must be available.
IX. An applicant may receive Medicaid coverage if the Medical Review Team (MRT) determines that s/he is presumptively disabled or blind and meets all other financial and non-financial requirements for Medicaid. A final determination must be made within six months of the presumptive decision.
A. Presumptive eligibility entitles the individual to full Medicaid benefits. If subsequently found not medically or otherwise eligible, adequate and timely notice must be given before coverage stops.
B. The start date for presumptive decisions is the first day of the month in which the decision is made. If the final decision is that the individual is not eligible, the closing will take place even if a hearing is requested. A reconsideration cannot be done.
C. If an individual’s prior application has been denied base on medical factors, a presumptive decision can be made only when there is sufficient evidence of an worsening of his/her physical or mental condition (or the existence of a new impairment) which could demonstrate a strong likelihood that the subsequent presumptive decision should be allowed.
D. A presumptive decision can be made when the alleged impairment falls within the following categories:
1. amputation of two limbs or a leg at the hip;
2. total deafness or blindness;
3. a stroke more than three months ago with continued marked difficulty in walking or using a hand or arm;
4. cerebral palsy, muscular dystrophy or muscle atrophy;
5. diabetes with amputation of a foot;
6. Down Syndrome;
7. Intellectual Disability;
8. HIV infection;
9. a child age 6 months or younger showing low weight at gestational age (age at birth based on date of conception);
10. a physician or knowledgeable source confirms an individual is receiving hospice services due to terminal cancer; or
11. spinal cord injury producing the inability to ambulate without the use of a walker or bilateral hand-held assistive device.
Section 4.3.2: Referral to Vocational Rehabilitation
Persons under age 65 who are blind or disabled, are to be referred to Vocational Rehabilitation for review of the individual's need to use their services.
Section 4.3.3: Reconsiderations (Appeals)
An individual may request a reconsideration (appeal) within thirty days of notification of the disability decision. A reconsideration is done when additional information regarding the original impairment is available. If requested within ten days of the date of the denial notice, the original application date is used and temporary coverage may be granted on the 46th day.
For individuals being closed because it has been determined that they are no longer disabled, coverage will continue if a reconsideration is requested within ten days of the closing notice.
Any request for reconsideration made more than thirty days from the date of the notice of the disability decision requires a new application.
Section 4.3.4: Determination of Continued Eligibility when the Disabled Individual Begins to Work
When earnings are reported the Medical Review Team (MRT) will be alerted when:
I. a medical review has not been done nor has one been scheduled in the past or coming six months. These are usually situations of longer term disability such as asthma. The MRT will reschedule a review within the next six to twelve months. This gives the individual an opportunity to try the job, on an ongoing basis, to see if work is possible on this basis.
II. the MRT has identified the situation as one in which recovery is expected even if a review has been done or is expected to be done in the past or coming six months. In this instance the MRT may do a complete review regardless of the scheduled review date and request current medical information if recovery is expected within six months. Usually these are situations with a short term disability such as recovery from an accident.
If the individual is not scheduled for further medical review, the MRT does not need to be alerted when earnings are reported, but any earnings must be budgeted. These are usually situations of terminal illness or severe disability with no chance of recovery.
Section 5.1: Definitions
When determining SSI - Related eligibility, individuals are considered to be eligible individuals, ineligible spouses, eligible couples or an eligible child.
An "eligible individual" is the person who is applying for or receiving Medicaid.
An "ineligible spouse" is the person to whom the individual is married, who is living with the individual, and who is not applying for or is not receiving Medicaid. The spouse can choose to be an ineligible spouse.
An "eligible couple" are married individuals, living together, who both have made application for or are recipients of SSI, the State Supplement or SSI - Related Medicaid. Both individuals must meet all eligibility criteria. It is not possible to treat each spouse as an eligible individual if they are living together. Each spouse is considered an eligible individual effective the month after they cease to live together. For married couples who are residing in the same nursing home room (see Part 14, Section 4.2) or who are applying for waiver services in the community (see Part 13, Sections 4 and 6), special criteria may need to be considered.
An individual whose marriage has been terminated through death, divorce or annulment is considered not married.
An "eligible child" is an individual who has a disability or visual impairment and who is neither married nor the head of a household and
* under age 18; or
* under age 22 (through age 21) and a student regularly attending school or college or training designed to prepare him/her for a paying job. The child/student can have the student earned income exclusion (See Part 17, Section 4.54) and an ineligible child allocation (See Part 7, Section 2.2.1).
Child status ends effective with the month after the month of attainment of age 18 (age 22 if a student) or the month after the month s/he last meets the definition of a child.
Section 5.2: Eligible Groups
All SSI - Related Medicaid eligible individuals and couples must meet financial guidelines and be a member of one of the following groups:
Section 5.2.1: Individuals or Couples Meeting SSI/State Supplement Criteria
Individuals or couples who meet the criteria for SSI or the State Supplement and who have not applied or who do not want to apply for either or both cash payments.
Section 5.2.2: Individuals or Couples Eligible Under the Pickle Amendment or Lynch VS. Rank
Commencing 4/1/77, those individuals or couples formerly entitled to concurrent benefits from SSI and Social Security who would be eligible for SSI if annual cost of living adjustments are not counted (See Appendix C for specifics).
Section 5.2.3: Individuals or Couples Residing in Adult Foster Homes (Private or State Assisted) or Flat Rate Boarding Homes
Individuals or couples who are residing in these homes have special income guidelines for State Supplement eligibility. If income exceeds these special guidelines the individual or couple may still be eligible for MaineCare (See Part 12).
Section 5.2.4: Individuals or Couples Residing in Cost Reimbursement Boarding Homes, and Residential Care Facilities
Individuals or couples who are residing in these homes have special income limits for MaineCare coverage (See Part 12).
Section 5.2.5: Individuals in Nursing Care Facilities
Individuals must be in a facility licensed by the Department of Health and Human Services to provide nursing care services. There are four types of facilities:
I. General Hospitals (Awaiting Placement)
II. Skilled Nursing Care Facilities (SNF)
III. Intermediate Nursing Care Facilities (ICF)
IV. Nursing care sections of the following institutions for the care of the mentally disabled:
A. Riverview Psychiatric Center (RPC)
B. Dorothea Dix Psychiatric Center (DDPC)
Individuals in these types of facilities must meet special eligibility criteria (See Part 14).
Section 5.2.6: Individuals Receiving Nursing Care in Community Settings
There are programs available for individuals who require nursing home care and are living in the community. These programs are called "Home and Community Based Waiver Programs" because they provide special services and follow special eligibility criteria (See Part 13).
The waiver programs are:
I. Home and Community Benefits for the Elderly and for Adults with Disabilities Waiver
II. Support Services for Members with Intellectual Disability or Autistic Disorders
III. Home and Community Benefits for Members with Intellectual Disabilities or Autistic Disorder Waiver
IV. Home and Community Based Waiver Benefit for Children with Intellectual Disabilities and/or Pervasive Developmental Disorders (ID and/or PDD)
V. Home and Community Based Waiver Benefit for Adults with Other Related Conditions Aged 21 and Over
VI. Home and Community Based Waiver Benefit for Adults with Brain Injury
Section 5.2.7: Newborns Born to Mothers on Medicaid
If the newborn’s mother is receiving Medicaid (or is covered as part of the retroactive period) on the date the baby is born, the baby is eligible for coverage regardless of the newborn’s income or assets. The mother must be fully covered by Medicaid on the day of the baby’s birth. In other words, if mother meets the deductible amount on the day of the baby’s birth and is partially responsible for any medical bills on that date, the newborn is not eligible in this group.
Coverage continues for one year. This means that the baby is eligible without regard to: changes in family income or composition, cooperation with DSER, cooperation with TPL, obtaining a Social Security number or declaring citizenship status.
Section 5.2.8: Children Eligible Under “Katie Beckett”
Individuals under this eligibility option are children with disabilities, age 18 and younger, who are living in the community and would be eligible for Medicaid if they were in need of institutional level of care. There are no special services provided to this group (See Part 7, Section 5).
Section 5.2.9: Certain Individuals Receiving Social Security Disabled Widow(er)’s Benefits who are not Receiving Medicare
These are individuals who are not eligible for Medicare and who lost their SSI or State Supplement benefits due to receipt of disabled widow(er)'s benefits from Social Security. If the individual meets all other SSI criteria and would be eligible for SSI or State Supplement benefits if the amount of Social Security benefits received as a disabled widow(er) were excluded income, the individual is eligible for categorically needy, SSI - Related Medicaid coverage. The exclusion of income from the Social Security disabled widow(er) continues until the individual is eligible for Medicare or would be ineligible for SSI or State Supplement benefits for a reason other than the income from Social Security disabled widow(er)'s benefits.
Section 5.2.10: Disabled Adult Children (DAC)
A Disabled Adult Child is an individual who lost his/her eligibility for SSI or State Supplement on or after 7/1/87 due to an increase in or initial receipt of Social Security Benefits based on their DAC status. These individuals who maintain their DAC status with Social Security may continue to receive Medicaid coverage. In determining eligibility for Medicaid, the increase in Social Security Benefits that resulted in SSI ineligibility will be disregarded. Other changes in income will be taken into account and will affect eligibility. Countable income must be under the current SSI or State Supplement income limit.
A person receives Social Security Benefits under DAC status if the following conditions are met:
I. s/he is the child (or eligible grandchild) of a retired, deceased or disabled worker;
II. the individual is at least 18 years of age; and
III. disability (including blindness) began before age 22.
Individuals may lose coverage under this group and later regain it. Continued eligibility is not necessary.
Section 5.2.11: Other Covered Groups
Within this section there are other groups which are included in Federal Law. These are listed in Appendix D for informational purposes.
Section 5.2.12: Individuals under Age 18 Who are Closed From SSI Due to August, 1996 Change in Disability Criteria
Individuals under age 18 are Medicaid eligible if the individual:
I. was in current pay status with SSI in August, 1996;
II. is closed due to not meeting the child disability standards that became effective on 8/23/96;
III. continues to meet the SSI child disability criteria in effect prior to 8/23/96; and,
IV. continues to meet federal SSI income and resource standards.
If the individual is closed from SSI for a reason other than not meeting the changed disability criteria, such as being over income or assets, or failing to cooperate in establishing eligibility, this protected status does not apply and the individual must then meet current Medicaid eligibility criteria.
Once an individual has been receiving Medicaid under this protected status and they fail to meet any of the criteria in I – IV above, the protected status is lost and eligibility is determined using the current Medicaid criteria.
Section 5.2.13: Working Disabled
This coverage group includes individuals who meet the SSI standard for disability and who have earnings subject to federal tax withholding but are not eligible for Medicaid under any other coverage group. These individuals may buy into Medicaid by paying a monthly premium if the specific requirements of this coverage group are met. This is an SSI - Related coverage group using SSI - Related rules for treatment of income and assets, however, there are income and asset limits specific to this coverage group.
Section 5.2.14: Section 1619(b)
Section 1619(b) refers to the section in the Social Security Act which authorizes coverage for this group. These are individuals who are considered disabled by SSI but their earned income disqualifies them for an SSI payment. However, due to the use of a higher income guideline by SSI, they continue to be carried by SSI case as an open case and they are Medicaid eligible.
Assets, other than those excluded in Part 16, must be under the following limits on any day of the month to be eligible for that month.
Section 1.1: Categorically Needy Asset Limit
$2000 for a single individual, a married individual not living with a spouse or a child.
$3000 for an individual living with an ineligible spouse or an eligible couple.
Section 1.2: Working Disabled Asset Limits
$8000 for a single individual, a married individual not living with a spouse or a child.
$12,000 for an individual living with an ineligible spouse or an eligible couple.
Section 1.3: Deeming of Assets
When an eligible individual is living in the same household with an ineligible spouse, or if the eligible individual is a child under age 18 residing in the same household with a parent, the assets of the spouse or parent must be included in determining eligibility.
The assets of an ineligible spouse, or parent living with the individual, are deemed to the individual and are combined with the applicant's own assets.
Section 1.3.1 Exclusions to Deeming Process
The assets listed below are excluded in determining the amount of the ineligible spouse's or ineligible parent's assets:
I. Assets excluded in Part 16 are also excluded here.
II. Assets owned by a stepparent.
III. Pension Funds (and other retirement accounts) which belong to the ineligible spouse or ineligible parent.
IV. Parent's assets are not considered in determining eligibility for the "Katie Beckett" coverage group.
V. If the asset is only in the child's name, then it does not affect the parent's eligibility since there is no deeming from child to parent.
VI. In determining eligibility for a child some assets may be deducted for legal parents and the balance applied to the child’s asset limit. No assets are deducted for a stepparent.
The non-excluded assets of the parent in excess of $2000 (if the child is living with one legal parent) or $3000 (if the child is living with both parents) are deemed to the child and combined with the child's own non-excluded assets. The combined amount of deemed and own assets must be under the $2000 limit.
Example
The legal parents of Joe have non-excluded assets that total $4000. Joe has $200 of non-excluded assets of his own. We will deem $1000 of the parent’s assets to Joe. Joe now has $1200 of countable assets which will be applied against his $2000 asset limit.
Section 1.3.2: Duration of Deeming
I. Deeming ends the month after the ineligible spouse and eligible individual cease to live together for any reason.
II. Deeming from parent to child stops the month after the child reaches age 18 or the month after the child no longer resides with the parents.
This section describes the method used to budget income of household members when eligibility is being determined for SSI - Related Medicaid (see also Part 17 – Income).
Section 2.1: Disregards
The following are deducted from the individual's or couple's gross non-excluded income in this order:
Section 2.1.1: Federal Disregard
Twenty dollars a month from earned or unearned income.
Note: The $20.00 disregard is not applied to income based on need. This means there is no $20.00 exclusion of a VA Pension or Veteran's Financial Assistance (which is based on need). The $20.00 disregard does apply to VA Compensation (which is not based on need).
Section 2.1.2: Impairment - Related Work Expenses (IRWE)
Impairment - Related Work Expenses (IRWE) are to be deducted from a SSI - Related disabled individual's gross earnings. IRWE allowable deductions and limits are outlined in Appendix B.
Section 2.1.3: Earned Income Disregard
$65.00 is deducted from earned income. One half of the remaining earnings is also disregarded. This does not pertain to Sheltered Workshop Income (See Section 2.1.5 of this Part).
Section 2.1.4: State Disregard
The State of Maine also allows an added deduction of $55.00 for an individual and $80.00 for a couple.
Note: There is no $55.00 state disregard of income when determining eligibility for State Supplement for individuals residing in residential care living arrangements defined in Part 12, Section 1.
Section 2.1.5: Special Group Disregards
I. Pickle Disregard
Individuals or couples covered under the Pickle Amendment (see Appendix C) have all Cost of Living Adjustments (COLA's) to Social Security benefits received since the closure of concurrent entitlement for SSI or State Supplement and Social Security disregarded. This disregard applies also to COLA increases of the spouse even if the spouse is not eligible as a Pickle.
II. Disabled Adult Children Disregard
Individuals or couples receiving Social Security benefits as Disabled Adult Children have a portion of their Social Security benefits disregarded. The amount of the disregard equals the amount of either the increase in, or the initial receipt of, DAC benefits that resulted in SSI ineligibility..
The individual or couple loses this disregard when they marry, unless they marry another DAC.
III. Disabled Widow(er) (DWB) Benefit Disregard
The amount of the disregard as a Disabled Widow(er) is the amount of the Social Security benefits that caused the loss of SSI or State Supplement benefits. Disabled Widow(er)s maintain this status when they marry as long as they are still disabled.
IV. Shelter Workshop Disregard
Subtract $20 Federal disregard, if not previously deducted
Subtract $50 from remaining sheltered workshop income
Subtract 1/2 of remaining sheltered workshop income
Section 2.2: Deeming of Income
When an eligible individual is living in the same household with an ineligible spouse, or if the eligible individual is a child under age 18 residing in the same household with a parent, the income of the spouse or parent must be included in determining eligibility.
The income of an ineligible spouse, or parent living with the individual is deemed to the individual, and is combined with the applicant's own income.
Section 2.2.1: Allocation
Before income is deemed an amount is deducted from income which is set aside for the support of certain individuals other than the eligible individual. Specifically:
I. Ineligible child allocation
A. when determining eligibility for an eligible child, allow an allocation from the parent’s income for each ineligible child living in the household. In a household where there is a stepparent to an eligible child, use the legal parent’s income to meet the allocation for mutual children.
B. when determining eligibility for an individual or a couple, allow an allocation from the parent’s income for each ineligible child living in the household.
1. for SSI, the State Supplement and when using the Pickle, DWB, or DAC disregards, an allocation is allowed only from the income of an ineligible spouse
2. in other Medicaid determinations, an allocation is allowed from the income of the eligible individual or couple as well as the ineligible spouse.
3. stepparents can allocate to legal children only (including mutual), not to step-children.
4. allow an allocation for a child who is under age 22 (through age 21) and a student regularly attending school or college or training designed to prepare him/her for a paying job. The allocation can be used for a child who is away at school as long as they are considered to be temporarily absent. A child away at school is considered temporarily absent if s/he returns home on some weekends, holidays, or vacations and parent(s) have authority to make decisions on the child’s behalf whether or not this authority is exercised.
5. allocations from a spouse's or parent’s income for an ineligible child in the household (or temporarily absent from the household) end the month the child attains age 18, or if a student, age 22.
6. the amount of the allocation is equal to the difference between the ineligible child allocation amount in Chart 3 and the ineligible child’s gross monthly income. Gross monthly income for this purpose is gross non-excluded income (Part 17) minus the specific exclusions in Section 2.2.2 of this Part.
II. Parent Allocation - when determining eligibility for an eligible child:
A. deduct an amount from an ineligible parent’s own income when deeming parental income to an eligible child. This is the parent allocation.
B. the amount is equal to the parent’(s) allocation in Chart 3.2.
C. step-parents are not included in the parent allocation.
Section 2.2.2: Exclusions to Deeming Process
I. The following is excluded income when determining the income to be deemed from the ineligible spouse to the eligible spouse:
A. All income that is excluded for an eligible individual.
B. Income from TANF, General Assistance or federal program benefits that are based on need (such as Veteran’s Pension). In addition, exclude any income that was counted or excluded by any of these benefits.
C. Income used to comply with the terms of court ordered support and Title IV-D support payments.
D. When deeming from an ineligible spouse to an eligible spouse, exclude an amount equal to the “ineligible spouse standard” in Chart 3.5. This exclusion is taken first from unearned income and any remainder is taken from earned income.
II. The following is excluded income when determining the income to be deemed from an ineligible parent to an eligible child:
Note: Income is not deemed from a stepparent. When looking at the parent allocation, look at the amount for a one-parent household. The eligible child is treated as "living with others”.
A. All income that is excluded for an eligible individual.
B. Income from TANF, General Assistance or federal program benefits that are based on need (such as Veteran’s Pension). In addition, exclude any income that was counted or excluded by any of these benefits. No parent allocation is made.
C. Income used to comply with the terms of court ordered support and Title IV-D support payments.
III. The following is excluded income when determining the income of an ineligible child to whom an income allocation is made:
All income that is excluded for an eligible individual with one exception. There is no one-third exclusion of child support received for the ineligible child.
Note: An ineligible child allocation is not made to a child who is receiving TANF, SSI or State Supplement.
IV. When determining eligibility for a child:
If siblings receive SSI or State Supplement, treat them as eligible children in the budgeting process. Exclude the SSI or State Supplement payments the siblings receive.
Section 2.2.3: Duration of Deeming
I. Deeming ends the month after the ineligible spouse and eligible individual cease to live together for any reason.
II. Deeming from parent to child stops the month after:
A. the child reaches 18; or
B. the month after the child no longer resides with the parents for any reason.
The following describes budgeting for:
* SSI or State Supplement for eligible individuals.
* Pickle, DAC, DWB for eligible individuals.
* Categorically Needy Medicaid for eligible individuals.
* SSI, State Supplement and Categorically Needy Medicaid for eligible children.
Note: If an individual is over income or assets under Categorically Needy, eligibility needs to be determined under Medically Needy criteria (See Part 10).
Section 3.1: Budget for SSI or State Supplement Payment
I. Combine all gross unearned income.
II. Subtract the $20.00 Federal Disregard where applicable. The remainder is the net unearned income.
III. Combine all gross earned income.
IV. Subtract any remainder of the $20.00 Federal Disregard not deducted from unearned income.
V. Subtract any Impairment-Related Work Expenses (IRWE) outlined in Appendix B.
VI. Subtract the earned income disregard of $65.00.
VII. Divide the remaining earned income by two. The remainder is net earned income.
VIII. Combine net earned and unearned income. The remainder is total net income.
If total net income is below the appropriate SSI Income Standard for one, based on living arrangement, the individual meets the income criteria for an SSI payment.
If receiving SSI, the individual also gets a State Supplement. If over income for SSI, s/he may be eligible for a State Supplement only payment.
IX. Subtract the State Disregard for one ($55.00), except for those in living arrangements D, E, F, G, I (See Chart 3.6). The remainder is countable income.
If countable income is below the appropriate State Supplement Income Standard for one, based on living arrangement, the individual meets the income criteria for the State Supplement only payment (See Part 11 for more information on State Supplement eligibility).
Section 3.2: Budget for Medicaid Coverage Under Pickle Amendment or Disabled Adult Child (DAC) or Disabled Widow(er) Disregards
Follow the budgeting process in Section 3.1 for an individual, except that the Pickle, DAC, and/or DWB income disregard(s) are subtracted after step I. and before step II (Federal Disregard).
Follow the budgeting process for a disabled child in Section 3.4 of this Part. In determining the child’s countable income deduct the Pickle disregard between steps I and II (Federal disregard).
If countable income is below the State Supplement Income Standard, the individual is Medicaid eligible.
Section 3.3: Budget for Categorically Needy Medicaid Coverage
Individuals who are not eligible under Section 3.1 or Section 3.2 or who choose not to apply for SSI/State Supplement, may get Medicaid coverage (if otherwise eligible) by using the following budget process.
I. Combine all gross unearned income.
II. Subtract the $20.00 Federal Disregard, where applicable. The remainder is the net unearned income.
III. Subtract any allocation to an ineligible child. An ineligible child is one who is not receiving TANF, SSI or State Supplement.
To determine the allocation, deduct each child’s countable income from the maximum child allocation (see Chart 3.2). The remainder for each child is combined to determine the total allocation. The remainder is the individual’s net unearned income.
IV. Combine all gross earned income.
V. Subtract any remainder of the $20.00 Federal Disregard not deducted from the unearned income.
VI. Subtract any remainder of the ineligible child allocation not deducted from the unearned income.
VII. Subtract any Impairment-Related Work Expenses (IRWE) outlined in Appendix B.
VIII. Subtract the earned income disregard of $65.00.
IX. Divide the remaining earned income by two. The remainder is net earned income.
X. Combine the net earned and unearned income.
XI. Subtract the State Disregard for 1 ($55.00). The remainder is the countable income.
If countable income is equal to or below 100% of the Federal Poverty Level for one and eligibility is based on age or disability, the individual is Medicaid eligible.
Note: The State Supplement budgeting criteria must be used for an individual whose eligibility is based solely on blindness. However, if the individual also meets the SSI criteria for disability use the budgeting criteria in this section.
If countable income is greater than the Federal Poverty Level for one, go to the Medically Needy Part 10.
Section 3.4: SSI, State Supplement and Categorically Needy budget for a child
I. Unearned Income to the Eligible Child(ren)
A. Subtract the allocation for ineligible children and/or aliens from the parental unearned income.
B. If the allocations are greater than the unearned income, or there is no unearned income, subtract the excess allocations from the parental earned income.
C. Subtract the $20.00 Federal Disregard from any remaining parental unearned income.
D. If the remaining unearned income is less than $20.00, subtract the remainder of the $20.00 from the parents’ combined earned income.
E. Subtract $65.00 from the remaining earned income.
F. Subtract one-half the remaining earned income from the result of Step V.
G. Add the result of Step III (countable unearned income) to the result of Step VI (countable earned income).
H. Subtract the parental living allowance (see Chart 3.2) from the result of Step VII (parental countable unearned and earned income).
I. Divide the result of Step VIII by the number of eligible children in the household. This is unearned income to the eligible child(ren).
If there is more than one eligible child in the household, divide the deemed income equally among them. However, do not deem in excess of the amount which, when combined with the child's own income, would make the child ineligible. That excess is deemed in equal amounts among the other eligible children in the household in addition to their equal shares of the deemed income (See Example 2 below).
II. Determine the child's countable income:
A. Combine the deemed income with the child's own unearned income.
B. Subtract the $20.00 Federal Disregard. The remainder is the net unearned income.
C. Combine all gross earned income.
D. Subtract any remainder of the $20.00 Federal Disregard not deducted from the unearned income.
E. Subtract any Impairment Work-Related Expenses (IRWE) outlined in Appendix B.
F. Subtract the earned income disregard of $65.00.
G. Divide the remainder by two. The remainder is the net earned income.
H. Combine the net earned and unearned income.
I. Subtract the State Disregard for one (see Chart 3.1). The remainder is the countable income.
If the countable income is below the SSI/State Supplement Income Standard for one, see Chart 3.4, (living in the household of another) the child may be eligible for a SSI / State Supplement payment (See Part 11).
If countable income is equal to or below 100% of the Federal Poverty Level for one the child is Medicaid eligible.
If countable income is greater than the Federal Poverty Level for one, go to the Medically Needy Part 10.
Examples
1. Mr. and Mrs. Fry have two children, Linda (age 10) and Mike (age 11). Mike has been found disabled through the Medical Review Team. Mr. Fry earns $600 weekly. There is no other income for the family.
$ 600 weekly gross income (Mr.)
X 4.3
$ 2580 monthly gross income
- $ 319 ineligible child allocation to Linda
$ 2261
- $ 20 federal disregard
$ 2241
- $ 65 earned income disregard
$ 2176
- $ 1088 earned income disregard (1/2 the remainder)
$ 1088
- $ 956 living allowance for two parents (Chart 3.2)
$ 132 deemed to Mike
- $ 20 federal disregard
$ 112
- $ 55 state disregard
$ 57 countable income for Mike
Mike’s income is less than the SSI/State Supplement standard for one. He is eligible for Medicaid and may be eligible for SSI.
If the countable income was equal to or above the appropriate SSI/State Supplement Standard compare the countable income to 100% of the Federal Poverty Level for one.
2. Kevin and Beth Ham have two children, Barbara and Dick, both of which meet disability criteria. Dick receives an annuity of $600 monthly due to an accident.
$3765.00 Kevin’s monthly earnings
- $ 20.00 federal disregard
$3745.00
- $ 65.00 earned income disregard
$3680.00
- $1840.00 earned income disregard (1/2 the remainder)
$1840.00
- $ 934.00 parent allocation
$ 906.00 income to be deemed to eligible children
The $906.00 would be deemed equally between the two eligible children. Doing so would make Dick over income. As a result, we will deem an amount to Dick up to the Categorical Income limit and the balance is deemed to Barbara. This will result in both Barbara and Dick being eligible for Medicaid.
$ 926.00 Categorical Income limit
$ 600.00 Dick’s annuity
$ 326.00 amount deemed to Dick
$ 906.00 income to be deem to eligible children
- $ 326.00 amount deemed to Dick
$ 580.00 amount deemed to Barbara
The following describes budgeting for an eligible couple or eligible individual with an ineligible spouse:
* SSI or State Supplement
* Pickle, DAC, DWB
* Categorically Needy Medicaid
* SSI, State Supplement and Categorically Needy Medicaid
Note: If over income or assets under Categorically Needy, eligibility needs to be determined under Medically Needy criteria (See Part 10).
In SSI - Related coverage groups, when one spouse is receiving an SSI/State Supplement benefit, that spouse is included in the assistance unit. The SSI/State Supplement payment is excluded income. All other countable income of the SSI/State Supplement recipient is used to determine eligibility for the assistance unit.
Example
Barb VanMarpel receives SSDI of $600 and SSI of $57.00. Her husband Antonio, age 83, has retirement income of $300, monthly. Barb is eligible for Medicaid because she receives SSI. Eligibility needs to be determined for Antonio. The budget for his eligibility will use Barb’s SSDI of $600 and his retirement of $300. The budgeting process used is for an eligible couple.
Section 4.1: Budget for SSI or State Supplement Payment
I. Budget for an Eligible Couple
Follow the budgeting steps for an individual with the following exceptions:
A. the income of the couple is used
B. the State Disregard for two is used in Step IX ($80.00).
C. Net income is compared to the SSI Income Standard for two based on living arrangement.
D. If ineligible for SSI, countable income is compared to the State Supplement Income Standard for two based on living arrangement.
II. Budget for an Eligible Individual with an Ineligible Spouse
A. Pretest
The individual must have countable income less than the SSI or State Supplement Income Standard for one.
1 Determine the eligible individual's countable income, using steps I – IX in Section 3.1.
2 If this figure is equal to or greater than the SSI or State Supplement Income Standard for one the individual does not meet the pretest and is not eligible under this section.
3 If this figure is less than the SSI or State Supplement Income Standard for one, based on the living arrangements (see Chart 3.4), the individual is potentially eligible for SSI or State Supplement.
The SSI or State Supplement budgeting process continues with deeming income from the ineligible spouse.
B. Deeming of income from the ineligible spouse
Note: See Section 2.2.2 of this Part on Deeming of Income for special income exclusions allowed from the income of an ineligible spouse.
1. Combine all of the ineligible spouse’s unearned income.
2. Subtract any allocation to an ineligible child. An ineligible child is one who is not receiving TANF, SSI or State Supplement. To determine the allocation, deduct each child’s countable income from the maximum child allocation (see Chart 3.2).
The remainder for each child is combined to determine the total allocation.
Note: For SSI or State Supplement eligibility, only the ineligible spouse can allocate income to an ineligible child.
The remainder is the spouse’s net unearned income.
3. Combine all of the ineligible spouse’s earned income.
4. Subtract any remaining child allocation from the earned income.
The remainder is the spouse’s net earned income.
C. Eligibility of the Eligible Spouse
1. Combine the individual’s gross unearned income with the spouse’s net unearned income (after the child allocation has been deducted).
2. Subtract the $20.00 Federal Disregard, where applicable.
3. Combine the individual’s gross earned income with the spouse’s net earned income (after any remaining child allocation is deducted).
4. Subtract any remainder of the $20.00 Federal Disregard not deducted from the unearned income.
5. Subtract any Impairment-Related Work Expenses (IRWE) outlined in Appendix B.
6. Subtract the earned income disregard of $65.00.
7. Divide the remaining earned income by 2. The remainder is the net earned income.
8. Combine the net earned and unearned income. This is the total net income.
If total net income is below the SSI Income Standard for two, based on living arrangement, and the individual met the pretest, the eligible individual meets the income criteria for an SSI and State Supplement payment.
If over income for SSI, s/he may be eligible for just a State Supplement payment.
9. To determine if the eligible individual can receive just a State Supplement payment subtract the State Disregard for two ($80.00), except for those in living arrangement D, E, F, G (See Part 11). The remainder is the countable income.
If the countable income is below the State Supplement Income Standard for two, (See Chart 3.4) based on living arrangement, and the individual met the pretest, the eligible individual meets the income criteria for just a State Supplement payment
Part 11 has additional information on State Supplement.
If countable income is greater than the Federal Poverty Level for one, go to the Medically Needy Part 10.
Section 4.2: Budget for Medicaid for Coverage Under Pickle Amendment or Disabled Adult Child (DAC) or Disabled Widow(er) (DWB) Disregards
Follow the budgeting process in section 4.1, steps A, B and C, except that the Pickle DAC, and/or DWB income disregard(s) are subtracted before the Federal Disregard.
If countable income is below the State Supplement Income Standard for two, the individual is Medicaid eligible.
Section 4.3: Budget for Categorically Needy Medicaid Coverage
A couple or an eligible individual with an ineligible spouse who is not eligible under 4.1 or 4.2 or who chooses not to apply for SSI/State Supplement, may get Medicaid coverage (if otherwise eligible) by using the following budget process.
Note: See Section 2.2.2 of this Part on Deeming of Income for special income exclusions allowed from the income of an ineligible spouse.
Combine all gross unearned income of the couple.
I. Subtract the $20.00 Federal Disregard where applicable.
II. Subtract any allocation to an ineligible child. An ineligible child is one not receiving TANF, SSI or State Supplement. To determine the allocation, deduct each child’s countable income from the maximum child allocation (See Chart 3.2). The remainder for each child is combined to determine the total allocation. The remainder is the net unearned income.
III. Combine all gross earned income of the couple.
IV. Subtract any remainder of the $20.00 Federal Disregard not deducted from unearned income.
V. Subtract any remainder of the ineligible child allocation.
VI. Subtract any Impairment-Related Work Expenses (IRWE) outlined in Appendix B.
VII. Subtract the earned income disregard of $65.00.
VIII. Divide the remaining earned income by two. The remainder is net earned income.
IX. Combine the net earned and net unearned income.
X. Subtract the State Disregard for two ($80.00). The remainder is countable income.
If countable income is equal to or below 100% of the Federal Poverty Level for two and eligibility is based on age or disability, the individual or couple is Medicaid eligible.
Note: The State Supplement budgeting criteria must be used for an individual or couple whose eligibility is based solely on blindness. However, if the individual or couple also meets the SSI criteria for disability use the budgeting criteria in this section.
Katie Beckett is a MaineCare coverage group for children who are ineligible under a Family - Related or any other SSI - Related coverage group and who:
I. are age 18 and under (up to age 19);
II. reside in the community (not in a medical institution);
III. meet the SSI/SSA criteria for disability; and
IV. need in-patient care provided by a hospital, nursing facility, psychiatric hospital, or an ICFMR. The cost of providing care outside the facility must not exceed the annual cost of institutional care needed by the child as determined by the Office of MaineCare Services.
V. If a child covered under Katie Beckett no longer resides with the parent(s), parental deeming under SSI - Related rules ends (See Section 2.2.3 of this Part). The child may then be eligible as SSI - Related and may not need the Katie Beckett coverage group.
Section 5.1: Income and Assets
If the criteria in I – IV above are met, the income and assets of the child only are considered in determining financial eligibility. Parental income and assets are disregarded. There is no cost of care and there is no penalty for transfer of resources.
I. The child’s gross income as defined in SSI - Related coverage must be less than or equal to the Categorical Nursing Care Limit (see Chart 4.1). If income exceeds this amount, the individual is not eligible.
II. The child’s countable assets as defined in Part 16 must be less than $2,000.
Section 5.2: Premiums
I. Except for Alaska Natives and Native Americans who are members of Federally-recognized Tribes, the Department must receive monthly premiums as described below, in order for the child to receive Katie Beckett coverage.
A. Amount
1. The amounts of the monthly premiums, based on family income as a percentage of the Federal Poverty Level, are identified in Chart 3.12.
2. The premium amounts in the chart apply to a family, regardless of the number of Katie Beckett children in the family.
3. For purposes of calculating family income as a percentage of Federal Poverty Level to determine monthly premiums, family size is the total of the child or children covered under the Katie Beckett group, his or her siblings and his or her parents who reside in the household. Family income is based on gross monthly non- excluded income of the family. Income excluded by SSI - Related coverage and stepparent income (unless the stepparent is to be counted in the family size) are both excluded.
a. There are no deductions or disregards from income.
b. Current income is projected over a twelve month period.
c. SSI - Related Medicaid rules are used in anticipating income and in the treatment of irregular, fluctuating, contract, seasonal and self-employment income.
d. Premium amounts due can be changed if there is a change in income or health insurance that is expected to last for more than a full calendar month. The change in premium amount is effective the month after the month the change in income or health insurance occurred, as long as the change
in income or health insurance is reported within ten days of its occurrence; otherwise, the change in premium is effective the month after the month the change in income or health insurance is reported. Adverse action notice will be given when a premium is increased.
e. There are two premium schedules:
i. a standard premium for children without any other creditable private health insurance coverage. Creditable insurance coverage is defined in 42 U.S.C. §300gg(c)(1) and includes any health benefits plan, individuals or group, a medical care program of the Indian Health Service or another tribal organization, any government insurance plan for Armed Forces, Peace Corps volunteers or government employees, provided by a carrier for the purposes of providing, paying for or reimbursing expenses for health services. Creditable insurance coverage does not include coverage which is limited in scope such as dental insurance or vision care insurance; and
ii. a discounted premium for children covered by a private health insurance plan.
Note: For families using the Private Health Insurance Program (PHIP) benefit, the standard premium schedule applies.
B. Payment
1. Payment is due to be received by the Department on the first day of the month for which the child receives coverage.
2. Premiums can be paid monthly, for more than one month at a time, or in advance for the twelve month eligibility period. Payments will first be credited to the earliest months of coverage during the current twelve month eligibility period. If retroactive coverage is granted according to Part 2, Section 13.4, then payment will also be due for the retroactive months of coverage. These payments for retroactive coverage will be created first.
For example: A monthly premium of $92.00 is due during the twelve month review period from January to December and the first payment of $92.00 is received on March 1st. Month one (January) will be credited with a premium paid. The February and March payments are overdue.
3. Payment must be paid up to date every three months. If not, advance notice of closing will be sent to end coverage the last day of the 3rd month.
For example: The 1st month of coverage is January. As of March 1st, premiums for January, February, and March are paid. As of June 1st, payments are received by DHHS for April, but no payment is received for May or June. Action is taken to end Medicaid coverage effective June 30th.
4. There is a grace period for nonpayment of premiums. The grace period extends through the last day of every 3rd month.
5. If payment is received the month following the month coverage has ended, a new medical assessment is not needed to determine if the child is in the need of institutional level of care. Reapplications for any following months require a new medical assessment. A prior decision on meeting the SSA disability criteria can be used if the review date of this decision is in the future.
6. If MaineCare coverage under the Katie Beckett group is closed due to non-payment or non-timely payment of a premium, coverage under Katie Beckett cannot be reinstated for twelve months starting with the month the closing is effective unless all past due premiums are paid in full.
7. Coverage under this group can be reinstated in fewer than 12 months if there is good cause for late or non-payment of premiums because of one of the following reasons:
a. mail delay;
b. illness of the parent; or
c. unanticipated emergency beyond the control of the parent or the responsible individual.
C. Refunds
A refund is due if an agency error occurs. Any adjustment will be limited to twelve months prior to knowledge that an agency error has occurred.
II. If a child under age 18 is getting Medicaid coverage through the SSI cash program and he/she becomes ineligible for an SSI cash payment due to the parents' income or assets, the child may continue to get full Medicaid coverage and a $40.00 payment through the SSI and State Supplement program if the child:
A. is disabled;
B. received SSI benefits while in a medical facility (hospital or nursing home) for at least one month; and
C. meets the inpatient level of care standard for Katie Beckett.
The SSI office will ask the state Department of Health and Human Services to see if the child meets the medical need standard for the Katie Beckett option. The SSI office will let the parents know if the child meets the criteria and can get the $40.00
payment from SSI/State Supplement as well as continued Medicaid coverage. SSI may refer to this option as the "waiver of parental deeming".
There is a two step test of income that must be met.
I. Countable unearned income must be equal to or less than 100% of the Federal Poverty Level.
II. Countable unearned and earned income subject to federal tax withholding must be less than 250% of the FPL.
Section 6.1: Earnings
The individual must have earnings subject of federal tax withholding but there is no minimum work requirement and no SGA earnings test.
Section 6.2: Disability
The individual must meet the SSI criteria for disability. This criteria is met if there is currently in effect a decision by the Social Security Administration that this disability criteria is met.
Section 6.3: Changes
If the individual becomes eligible for Medicaid without a premium because of a change in income and that change is expected to last for a full calendar month, the individual will be moved to Medicaid coverage without a premium. This change is made effective the month the change occurred as long as this change is reported within ten days of its occurrence; otherwise, it is effective the month the change is reported. “Occurrence” is the date the change takes place.
The individual will be given a refund for any prepaid months in which s/he is subsequently moved to coverage without a premium.
Section 6.4: Premiums
I. Due Date/Amount of Premium
A premium payment is due for each month the individual is open for Medicaid under this coverage group unless s/he is exempt from a premium as identified below.
If a couple is eligible under this coverage group, there is one premium for the couple based on the couple’s countable income.
Premiums are due on the first day of each month of coverage.
The premium amount is based on countable monthly income projected for the twelve month eligibility period and does not change. A premium is effective the month an individual is added for coverage under this coverage group. Any decrease in premium is effective the month the individual’s coverage under this group ends.
If countable monthly income is over 150% and equal to or less than 200% of the FPL, the monthly premium is $10.00. If countable monthly income is over 200% and less than 250% of FPL the monthly premium is $20.00
II. Exemptions from Premium Payment
An individual is exempt from a premium:
A. if countable income is less than or equal to 150% of the Federal Poverty Level;
B. if s/he is responsible for paying for their Medicare Part B premium; or
C. if there is good cause for premiums not paid or not paid when due because of one of the following reasons:
1. mail delay;
2. illness of the individual or their responsible relative; or
3. an anticipated emergency beyond the control of the individual or their responsible relative.
D. For periods of retroactive coverage or temporary coverage.
III. Payment of Premiums
A. Premiums can be paid monthly, for more than one month at a time, or they can be paid in advance for the twelve month eligibility period. Payments will be credited to the earliest months of coverage first, during the current 12 month eligibility period.
Example
A monthly premium of $10.00 is due during a twelve month eligibility period from January to December and the first payment of $50 is received on June 1st. Months one through five will be credited with a premium paid. The June payment is overdue.
B. When a premium is not paid by the first of the month in which it is due the Department will give notice of nonpayment.
C. There is a grace period for nonpayment of premiums. The grace period extends through the last day of the twelve month eligibility period.
Example
If the eligibility period is January through December, the individual has until December 31st to pay his or her premiums for the period January to December. If the last day of the month falls on a weekend or holiday the premium is then due on the next workday.
D. When eligibility under this coverage group ends prior to the end of the twelve month eligibility period, the grace period for premium payment extends to the last day of the month in which coverage under the Working Disabled group ends.
Example
An individual granted 10/07 has a review date of 9/08 but his coverage is changed to Medicaid without a premium for 12/07. The grace period for payment of premiums for October and November is November 30th.
E. When eligibility under this coverage group is continued pending a hearing and a premium is due, the grace period is the last day of the month for which coverage is provided.
Example
The premium for the month of July is due July 1st. The grace period extends to July 31st.
IV. Non Payment of Premiums
A. At the beginning of month twelve of the eligibility period, notification will be given if any premiums for the eligibility period have not been paid when due. The individual will be notified of the penalty to be imposed because of the nonpayment.
B. At the twelve month review a determination will be made as to whether there are any overdue premiums. If so, coverage under the Working Disabled group will end unless there is “good cause” for nonpayment. Coverage as Working Disabled cannot begin again until any unpaid premiums are paid.
V. Administrative Hearings
A. Coverage as Working Disabled continues pending a hearing decision if a hearing is timely requested even if the individual is not paying premiums that are due. If the individual was responsible for paying a premium prior to the proposed negative action, this premium will continue to be due.
B. If the individual is upheld at the hearing and they have overpaid any premiums s/he will be issued a refund.
The Medicare Savings Program (MSP), also known as the Buy-In, provides qualified Medicare eligible individuals with Medicaid coverage that pays for their Medicare premiums. The Department also provides additional benefits for Qualified Medicare Beneficiaries (QMB), which are detailed below.
The Social Security Administration (SSA) enrolls SSI recipients for the Buy-In of Medicare Part B premiums. If the individual needs assistance with payment of Medicare Part A premiums, DHHS enrolls the individual in Qualified Medicare Beneficiaries (QMB). See Section 4.1 of this Part.
Individuals may be eligible for Buy-In if they meet the criteria of one of the groups listed in Section 4 of this Part. If not open for or applying for MaineCare, these individuals need to file an application for Buy-In with the Department.
Individuals must meet the basic eligibility requirements for SSI - Related MaineCare described in Part 6, except for individuals who have been diagnosed with end stage renal disease (ESRD). Individuals with an ESRD diagnosis do not need to meet the age or disability requirements.
SSI - Related Categorically Needy MaineCare budgeting rules are used to determine Buy-In eligibility.
Buy-In is a separate benefit within Medicaid. As a result, one spouse of an eligible couple can choose to be an ineligible spouse to give Medicaid eligibility to the other, and at the same time the couple will both be considered for Buy-In eligibility.
Example
Mr. and Mrs. Mazure apply for MaineCare. Both have Medicare. Mr. Mazure has Social Security income of $920. Mrs. Mazure has Social Security income of $600. Using SSI - Related Categorically Needy budgeting for an eligible couple, both are eligible for Buy-In but over income for Medicaid. Mrs. Mazure has to see a specialist, and Mr. Mazure does not. Mr. Mazure can choose to be counted as an ineligible spouse for MaineCare. We then use the exclusions to deeming found in Part 7, Section 2.2.2, resulting in Mrs. Mazure being eligible for Medicaid, and both of them being eligible for Buy-In.
There is usually a delay between the time an individual is eligible for the Buy-In and the time the Buy-In premium payment begins. During this time, the individual continues to have premiums deducted from their Social Security benefits (See Appendix A).
Section 3.1: Individual Who Opted Out of Medicare
Individuals who are not automatically enrolled in Medicare Part A or B, are not entitled to premium-free Medicare Part A (such as those individuals over age 65 but who did not pay enough Medicare taxes), or who opt out of Medicare Part A and/or B coverage when it is first offered, are considered entitled to enroll in Medicare. These individuals are eligible to apply for Buy-In. The Department will start their coverage without waiting for open enrollment. The Medicare Part A and/or B start date will be the effective date of the Buy-in.
Section 4.1: Qualified Medicare Beneficiary (QMB)
Eligibility Requirements for QMB
A Qualified Medicare Beneficiary is an individual who:
A. is entitled to Medicare Part A or voluntarily enrolled in Medicare Part A;
B. effective July 1, 2024 has income equal to or less than 185% of FPL; and
C. may have assets. Effective January 1, 2024, there is no asset test.
Description of QMB Benefits
A. Medicaid pays the cost of Medicare Part A and/or B premiums, as well as satisfying Medicare Part A and B deductibles and coinsurances (See Appendix A).
B. An individual may be eligible for QMB and Medicaid at the same time.
C. Coverage begins the month after the month in which an eligibility decision is made that the individual is eligible as a QMB. There is no three-month retroactive period.
Section 4.2: Specified Low Income Medicare Beneficiary (SLMB)
The rules in this Section apply through June 30, 2024.
Eligibility Requirements for SLMB
A Specified Low Income Medicare Beneficiary is an individual who:
A. is entitled to Medicare Part A or is voluntarily enrolled in Medicare Part A;
B. has income over 150% of the Federal Poverty Level (FPL) and equal to or less than 170% of FPL; and
C. may have assets. Effective January 1, 2024, there is no asset test.
II. Description of SLMB Benefits
A. Medicaid pays the cost of Medicare Part B premium (see Appendix A).
B. An individual may be eligible for SLMB and Medicaid at the same time; and
C. Coverage begins the month of application, retroactive to three months (but not prior to 1/1/93).
Section 4.3: Qualifying Individual (QI)
Eligibility Requirements for QI
A Qualifying Individual is an individual who:
A. is entitled to Medicare Part A or is voluntarily enrolled in Medicare Part A;
B. effective July 1, 2024 has income more than 185% of the Federal Poverty Level (FPL) but less than 250% FPL; and
C. may have assets. Effective January 1, 2024, there is no asset test.
II. Description of QI Benefits
A. Medicaid pays the cost of the Medicare Part B premium.
B. The individual cannot receive Medicaid coverage and this benefit at the same time; and
C. coverage begins the month of application up to three months retroactive but no earlier than 1/1/98.
Section 4.4: Qualified Disabled and Working Individual (QDWI)
Eligibility Requirements for QDWI
A Qualified Disabled and Working Individual is one who:
A. is entitled to Medicare Part A;
B. is not eligible for Medicaid;
C. has lost entitlement to Social Security disability benefits due to excess income from wages;
D. has countable income equal to or less than 200% of the FPL; and
E. has countable assets less than or equal to $4000.
II. Description of QDWI Benefits
A. Medicaid pays the cost of the Medicare Part A Premium.
B. Coverage begins the month of application, up to three months retroactive.
The Benefit for People Living With HIV/AIDS is a section 1115 health care reform demonstration agreement between the Office of MaineCare Services and the Centers for Medicare and Medicaid Services. The Office for Family Independence determines eligibility for this benefit. This benefit provides limited MaineCare coverage to individuals with an HIV/AIDS diagnosis if they meet the medical and financial requirements identified in this section. This benefit is also known as the Special Benefit Waiver (SBW).
Individuals who do not meet the eligibility requirements for MaineCare, but who are HIV-positive and are at or below 250% of the federal poverty level, may be eligible for SBW. If an individual who is eligible for this benefit becomes eligible for full MaineCare coverage, they will be moved to the appropriate MaineCare full coverage group. This contingency includes someone who meets a deductible or has a reduction in income that qualifies them for full MaineCare coverage. If an individual, enrolled in a full MaineCare coverage group, becomes ineligible for that group, including someone who must meet a new deductible, but is eligible for SBW, that individual will be granted coverage through SBW. This enrollment will happen even if SBW has a wait list.
An individual cannot receive SBW coverage and the Maine Rx Plus or Low Cost Drugs for the Elderly and Disabled (DEL) programs at the same time. SBW coverage and DEL coverage can overlap when DEL is supplementing Medicare Part D.
1. Basic Eligibility Requirements
Basic Non-Financial eligibility requirements for receiving MaineCare coverage identified in Part 2 apply to this group. This condition includes meeting the requirements for residency, citizenship, social security numbers, assignment of rights to medical payments and support rights, as well as applying for Medicare. SBW has no age requirement.
A. Medical Eligibility
The individual must be diagnosed as HIV positive. This diagnosis is confirmed by the Maine Center for Disease Control (MCDC). The individual must also comply with a treatment regimen as defined by their licensed healthcare professional.
If an individual reports a disabling condition and is financially eligible for SSI-Related coverage, eligibility for full MaineCare coverage must be determined first. If the Social Security Administration has not completed a disability determination, this determination will be done by the Medical Review Team.
B. Assets
SBW has no asset criteria.
C. Income
Individuals must meet the SSI – Related financial eligibility requirements as listed in Part 7 to be financially eligible for SBW. The SSI - Related rules on income exclusions, in Part 17, are applicable to this coverage group. There is no deeming of income from the spouse. There is no cost of care.
Gross income must be equal to or less than 250% of the Federal Poverty Level.
When determining MaineCare coverage for a spouse not applying for, or enrolled in, SBW, the income and assets of both individuals are used to determine eligibility for the spouse.
2. Premiums
Premiums are set by the Office of MaineCare Services and increase 5% annually on January 1st.
Premium payments are due on the first day of each month that the individual is open for MaineCare under this coverage group. Some individuals may be exempt from premiums as identified below.
The premium amount is based on gross monthly income projected for the 12-month enrollment period. Premiums are effective the month that coverage begins for the individual and end effective the month that coverage ends under the waiver. Starting January 1, 2025, premium amounts due are posted online at https://www.maine.gov/dhhs/ofi/programs-services/health-care-assistance. Premiums, when added to other payments made by the household to Cub Care or MaineCare, will not exceed five percent of that household’s gross annual income.
A. Payment of Premiums
(1) Premiums can be paid monthly, in advance for multiple months, or they can be paid in advance for the 12-month enrollment period. Payments will be credited to the earliest months of coverage first, during the current 12-month enrollment period.
Example: A monthly premium of $37.73 is due during a 12-month enrollment period from January through December, and the first payment of $415.03 is received on December 1st. Months one through 11 will be credited with a premium paid. The December payment is overdue.
(2) When a premium is not paid by the first of the month in which it is due the Department shall send notice of nonpayment to the individual.
(3) There is a grace period for nonpayment of premiums. The grace period extends through the last day of the 12-month enrollment period, or 60 days from the first day of the month for which a payment is due, whichever is later.
Example A: If the enrollment period is January through December and an individual fails to pay the premium due for March, the individual has until December 31st to pay the March premium.
Example B: If the enrollment period is January through December and an individual fails to pay the premium due for December, the individual has until 60 days from December 1st to pay the December premium.
If the last day of the grace period falls on a weekend or holiday, the premium is due on the next business day.
(4) If eligibility under this coverage group ends prior to the close of the 12-month enrollment period, the grace period for premium payment extends to the last day of the month in which coverage under this group ends, or 60 days from the first day of the month for which a payment is due, whichever is later.
Example: An individual is granted coverage for January through December. In March, coverage is changed to full MaineCare without a premium. The grace period for payment of the January premium is 60 days after January 1st. The grace period for payment of the February premium is 60 days after February 1st.
(5) If eligibility under this coverage group is continued pending a hearing and a premium is due, the grace period is 60 days from the first day of the month for which coverage is provided.
Example: The premium for the month of July is due July 1st. The grace period extends to 60 days after July 1st.
B. Exemptions from Premium Payment
An individual is exempt from a premium if any one of the following conditions apply:
(1) Gross income is less than or equal to 150% of the Federal Poverty Level.
(2) Any one of the following reasons constitutes good cause for premiums not paid or not paid when due:
(a) Mail delay,
(b) Illness of the individual or illness of the person responsible for the individual’s premium payments, or
(c) Unanticipated emergency beyond the control of the individual or their responsible relative.
(3) During periods of retroactive coverage.
C. Changes in Premium Amount
If the individual’s income changes so that no premium is due, or the amount of premium increases or decreases, this change will be made as follows:
(1) The change in income must be expected to last at least a full calendar month;
(2) The change of the premium will be effective for the month the income changed if the change is reported within ten days of its occurrence. Otherwise, the change of premium is effective the month the change in income is reported; and
(3) The premium amount will be changed no more than once every six months.
D. Non-Payment of Premiums
(1) At the beginning of the last month of the enrollment period, notification will be sent if any premiums for the enrollment period are still due. The individual will be notified of the non-payment penalty to be imposed.
(2) At the 12-month review a determination will be made as to whether any premiums are overdue. If so, coverage for this benefit will end unless “good cause” for non-payment exists. Coverage cannot begin again until any unpaid premiums are paid. When the unpaid premiums are paid, and the individual is otherwise eligible, the individual is re-enrolled regardless of the existence of a wait list or the individual’s place on that list.
3. Administrative Hearings
A. Coverage for this benefit continues pending a hearing decision if a hearing is requested at any time during the Adverse Action Notice Period, even if the individual is not paying premiums that are due. If the individual was responsible for paying a premium prior to the proposed negative action, this premium will continue to be due. For complete rules regarding administrative hearings, see Part 1, Section 7 of this manual.
B. If the individual is upheld at the hearing and they have overpaid any premiums, a refund will be issued.
4. Wait List
Enrollment for this benefit is capped based on expenditures. If enrollment is frozen, individuals who have been determined to be medically and financially eligible will be placed on a wait list that is maintained by the Maine Center for Disease Control and Prevention (MCDC). The rules for the wait list are in the MaineCare Benefits Manual.
When the Office for Family Independence is informed by the MCDC that an individual’s coverage can start, financial eligibility will be updated before coverage for this benefit can start.
Medicaid is provided to women who are under age 65 and otherwise meet the eligibility guidelines set forth in DHHS Rules for the Maine Breast and Cervical Health Program (MBCHP), 10-144, Chapter 707 et seq. MaineCare coverage is also available for women diagnosed with breast or cervical cancer, or a pre-cancerous condition and who meet the eligibility guidelines set forth in DHHS Rules relating to the Breast & Cervical Cancer Prevention and Treatment Act (BCCPTA), 10-144 C.M.R. Ch. 708 et seq.
Individuals are initially authorized coverage under these groups based on data collected by the Maine Center for Disease Control and Prevention (MCDC) and transferred electronically to the Office for Family Independence (OFI). Coverage is continuous for one year or as long as the individual is in need of
treatment, whichever is longer. When eligibility under these groups ends, the individual will be reviewed by OFI for continued coverage under another MaineCare coverage group.
Basic Non-Financial eligibility requirements for getting Medicaid coverage identified in Part 2 also apply to these groups. This includes the rules on residency, citizenship, social security numbers, and assignment of rights to medical payments.
(Repealed effective December 31, 2013, filing 2013-321)
This coverage group is effective October 1, 2016.
The Limited Family Planning Benefit is a limited Medicaid benefit that provides coverage to individuals, regardless of gender, for family planning and related services.
Coverage is available only to individuals who have not been determined otherwise eligible for any Categorically Needy or Medically Needy coverage group. If an individual, who is eligible for this benefit, is determined eligible for any Categorically Needy or Medically Needy coverage group, they shall be moved to that coverage group. This change in coverage includes individuals who newly meet a deductible.
If an individual, enrolled in a full coverage group, becomes ineligible for that coverage (including someone who must meet a new deductible), but is eligible for Family Planning benefits, that individual can be enrolled in Family Planning coverage.
1. Basic Eligibility Requirements
Basic Non-Financial eligibility requirements for receiving MaineCare coverage identified in Part 2 apply to this group. This stipulation includes meeting the requirements for residency, citizenship, social security numbers, and assignment of rights to medical payments and support rights, as well as applying for Medicare. The Limited Family Planning Benefit has no gender or age requirements.
Pregnant individuals are not eligible for coverage under this benefit.
A. Assets
LFPB has no asset criteria.
B. Income
Individual income must be equal to or less than 209% of the Federal Poverty Level.
C. Budgeting
MAGI-based budgeting rules for Medicaid are used to determine countable income. The assistance unit only consists of the individual applying for coverage.
2. Presumptive Eligibility for the Limited Family Planning Benefit
Presumptive eligibility provides immediate, short term access to family planning services for individuals who are not otherwise enrolled in MaineCare. Eligibility for coverage is determined by qualified entities. Pursuant to a State Plan Amendment, these changes are effective October 1, 2020.
A. Limited Family Planning Benefit Provider Qualification Requirements
To become qualified to make presumptive eligibility determinations for Medicaid, a provider must—
(1) Participate as a Medicaid provider under the State of Maine’s State Plan;
(2) Notify the Office for Family Independence (OFI) in writing of its intention to make presumptive determinations under this Part;
(3) Accept training, administered by OFI, for all applicable staff on relevant MaineCare eligibility rules and regulations; and
(4) Receive approval from the Department to make presumptive eligibility determinations.
B. Eligibility for Presumptive Eligibility Determinations by Qualified Providers
Limited Family Planning Benefit Presumptive Eligibility determinations must be limited to persons who meet all eligibility requirements for LFPB as listed in Section 4 of this Part.
Additionally, LFPB presumptive eligibility is limited to no more than one period within a twelve-month period, starting with the effective date of the initial presumptive eligibility period.
C. Limited Family Planning Benefit Presumptive Eligibility Determination Process
A qualified provider must use a Limited Family Planning Benefit presumptive application to establish the applicant’s financial and non-financial eligibility. Applications may be accessed at the Department’s website; or by contacting the MaineCare Eligibility Program Manager by mail, phone, or e-mail. If the provider determines the applicant meets all the eligibility requirements for coverage under the LFPB, the provider shall determine that the applicant is presumptively eligible for the LFPB.
If eligible the provider must—
(1) Notify the Department of the determination within five business days after the date on which the determination is made if no application for Medicaid has been filed by that date;
(2) Provide the applicant with an approved standard MaineCare application; and
(3) Inform the individual at the time the determination is made that they must complete a full application with the Department no later than the last day of the month following the month in which the presumptive determination is made to see if benefits can continue.
For individuals determined not to be presumptively eligible, the provider must notify the applicant in writing, and orally if appropriate, of the reason for the determination.
D. Limited Family Planning Benefit Presumptive Eligibility Coverage Period
Once a provider determines an individual is presumptively eligible, Limited Family Planning Benefit coverage begins immediately and continues until the later of—
If a full application for Medicaid is filed prior to the last day of the month following the month presumptive eligibility was determined, the date on which the Department makes the final eligibility decision; or
The last day of the month following the month in which the presumptive eligibility determination was made if no application for Medicaid has been filed by that date.
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.
Section 1.1: Eligible Medically Needy Groups
The Medically Needy coverage groups are available to individuals who meet the categorical criteria of a Medical coverage but are ineligible because of excess income. Individuals eligible for the Medically Needy coverage groups include:
Persons who are aged, blind, or disabled (as defined in Part 6, Section 4)
Children under age 21
Pregnant Women
Parent/Caretaker Relatives (as defined in Part 3, Section 2.2)
Section 1.2: Ineligible Coverage Groups
Medically Needy coverage is not available to people in the following coverage groups:
Expansion Adults (as defined in Part 3, Section 2.4)
Medicare Savings Program (Part 8)
Limited coverage groups (as defined in Part 9)
Section 2.1: The Prospective Period
The Medically Needy eligibility period is the time period during which the individual or family is assigned a deductible. This time period begins the first day of the month the individual first applied for Medicaid (See Part 2 Section 11), or the first day of the month after the date Medicaid ended because of excess income. The time period lasts six consecutive months.
An applicant may choose to withdraw their application for the month of submission and start the Medically Needy period for the following month, which would alter the retroactive period. (See 2.2 below.)
The six-month deductible period is shorted if:
The individual will turn age 21 in less than six months;
The individual dies
The individual becomes eligible for categorical coverage; or
The individual voluntarily withdraws from the program.
Section 2.2: Retroactive Periods
The applicant may request a retroactive Medically Needy period of one, two, or three months preceding the month of application if they have incurred medical expenses.
When multiple months of retroactive Medically Needy coverage are requested, coverage will not be provided for the second or third month prior to the application month without including the preceding months (first or second) unless the individual is ineligible due to basic eligibility requirements. A single retroactive deductible period is quoted to cover all requested months. See Part 2 Section 13.4 for more details.
Section 3.1: Medically Needy Assets
Assets must be under the following limits on at least one day of the month to be eligible for that month.
For SSI - Related coverage groups:
$2000 for an individual not married or not living with a spouse, including an individual who is a child.
$3000 for an eligible couple or an individual living with an ineligible spouse
There is no asset limit for MAGI-based coverage groups.
Section 3.2: Medically Needy Income
Treatment of income varies depending on whether the person is receiving Medically Needy coverage in an SSI-Related or MAGI-based coverage group.
For SSI-Related groups, budgeting rules in Part 7 are used to determine countable income.
For MAGI-based groups, budgeting rules in Part 4 are used to determine the assistance unit and countable income, except that income of a non-responsible relative is not counted when determining the deductible. A responsible relative is defined as a spouse or a biological or adoptive parent of a child under age 19.
The countable income is compared to the Protected Income Level (PIL). The PIL is based on family size and can be found in Chart 5. When the individual or family’s net countable income is above the PIL a deductible must be met. Due to differences in income counting methodology applicable to categorically needy and Medically Needy coverage groups, an individual may be ineligible for coverage in a categorically needy coverage group but have countable income under the PIL for Medically Needy coverage. An individual in this situation receives Medically Needy coverage without first having to incur any medical costs.
Individuals who are ineligible under Categorically Needy and whose income is above the appropriate Protected Income Level (PIL) are not eligible for Medicaid until they meet a deductible. The deductible is met by applying incurred costs for necessary medical services to the deductible amount.
Section 4.1: Calculating the deductible amount
Determine the countable income.
Subtract the PIL for the appropriate assistance unit size (See Chart 5) from the countable income.
Multiply the result by the number of months in the eligibility period (usually six months).
The result is the deductible amount the individual or family must meet by applying incurred medical costs before coverage can begin.
The deductible amount must be reviewed prior to opening coverage. When changes occur that impact Medically Needy eligibility (e.g. changes in income or household composition), eligibility is redetermined and the deductible amount is recalculated. If the Medically Needy period ends or the deductible amount increases, the Eligibility Specialist must give the individual timely and adequate notice of the change. (See Part 2 Section 15.)
Section 4.2 Applying Incurred Costs
Bills or other acceptable verification of incurred medical expenses must be submitted within one year of the application date to be applied to the deductible.
To be counted toward the deductible, a bill must be for medical services that are medically necessary and for which the individual is legally liable. The cost of necessary medical services for individuals in the assistance unit and for individuals whose income or assets are or would be used in determining eligibility may be applied against the deductible.
For individuals who are included in more than one assistance unit, the cost of necessary medical services can be applied toward each deductible.
When an individual or family has sufficient costs to meet the deductible, but an accurate start date cannot be determined due to missing bills or pending insurance payments, eligibility begins for the first full month of eligibility. Eligibility is back dated when all information is provided.
The deductible may be met by using medical costs that were incurred prior to the deductible period. When the deductible is met in this manner, the individual is eligible for MaineCare effective the first day of the eligibility period. Otherwise, coverage will begin when the deductible is met.
Section 4.3 Medical Cost Responsibility
The medical expenses used to meet the deductible are the individual’s obligation and cannot be billed to Medicaid.
On the day the deductible is met, the individual may be partially responsible for the bills incurred on that date. When this occurs, the Department will inform the provider in writing that the individual is eligible for Medicaid on the day the deductible was met. The notice will also include the amount of the bill the individual is responsible for paying.
If bills from multiple providers were applied on the date the deductible was met, the individual’s responsibility must be distributed equally to each provider. To determine the individual’s responsibility for each provider:
Divide the remaining deductible amount by the total sum of charges for all providers with a bill on the day the deductible was met. Round the result to the 4th decimal place.
Multiply each individual provider’s bill by the result.
The result is the amount the individual is responsible for.
If medical bills that could have been used to meet the deductible are received for a period prior to the date the deductible was met, but between the first date of eligibility and the start of the Medically Needy period, a notice will be sent to the client and provider showing a zero responsibility for the client. These bills will be covered if they are submitted within one year of the date of the eligibility decision.
Medical costs are applied in the following order:
I. Verified medical insurance premiums, including Medicare.
Note: Indemnity insurance premiums are not allowed. These are policies that pay for length of stay or a condition (such as cancer) but not for a specific service.
II. Verified actual costs incurred during the eligibility period for medical or remedial care costs not covered under Medicaid such as eyeglasses, dental services and hearing aids for individuals over age 21.
III. Medical costs incurred during the eligibility period by individuals who are part of the assistance unit but not eligible for coverage (such as an ineligible spouse or deeming parent in an SSI - Related unit or the parents of an individual whose eligibility is based on being under age 21).
IV. The unpaid balance on a loan taken out to pay for an old medical bill which was incurred prior to the eligibility period provided:
The proceeds of the loan were used to pay the medical bill. Only the amount of the loan actually used to pay the old medical bill may be deducted. Any portion used for another purpose may not be deducted.
Neither the medical bill nor the unpaid balance of the loan was previously applied against another deductible.
Only the principal part of the unpaid balance may be used in the deductible - not the interest.
This provision allows the individual to use the liability to the lender in place of the liability to the provider.
V. Medical costs incurred prior to the eligibility period and not applied toward another deductible, and which are unpaid on the first day of the eligibility period, which resulted in eligibility.
Example
Individual has a medical bill of $5000. He has a deductible for January through June of $4500. He meets the deductible and in July incurs another $4500 deductible. The $500 remaining from the $5000 medical bill can be used towards the new deductible if it was not paid.
VI. Additional services or items necessary for medical treatment such as transportation, long distance telephone calls to medical providers, cost of lodging to receive treatment away from home and nonprescription items or drugs incurred during the eligibility period.
VII. Medicaid coverable costs, paid or unpaid, incurred during the eligibility period in order of service date, including the following medical costs:
A. Medical costs incurred during the eligibility period as long as they have not been written off by the provider during the eligibility period.
B. Medical costs paid with all state or local funds such as General Assistance, DEL and some payments by Vocational Rehabilitation (VR).
Once the deductible has been met, the eligible individuals in the assistance unit will be eligible for Medicaid for the remainder of the eligibility period or until information is provided which would change the eligibility.
The following types of medical bills cannot be considered toward a deductible:
I. Medical costs incurred and paid prior to the eligibility period.
II. Portions of medical costs applied toward a previous deductible, if the deductible is met.
III. Portions of medical costs paid by insurance, including Medicare adjustments.
IV. Medical costs paid by individuals or groups outside the assistance unit for which the individual has no obligation to repay. The exception is medical costs paid with all state or local funds such as General Assistance, DEL and some payments by Vocational Rehabilitation (VR).
V. Medical costs incurred by individuals who are not members of the assistance unit and whose income and assets are not used in determining eligibility.
VI. Payments on old medical bills incurred prior to the eligibility period.
VII. Medical costs incurred during a penalty period.
VIII. Unpaid costs of care to a medical institution or waiver agency during periods of eligibility.
Example
This example shows how medical expenses are applied to a deductible and the order in which they must be applied.
An individual, age 22, determined disabled in April, submits the following bills to meet a deductible of $3820 for April through September.
Determine that there are no changes to the deductible amount and that all of the bills submitted can be used toward the current remaining deductible:
Total Deductible: $3820.00
I. Medical Insurance premium ($79.05 monthly X 6) - $ 474.30
Remaining deductible $3345.70
II. Items not covered by Medicaid
Eyeglasses (purchased 4/12) - $ 125.00
Remaining deductible $3220.70
III. Old unpaid medical bills
Doctor’s statement shows an outstanding balance
as of 3/31 of $650.00 - $ 650.00
Remaining deductible $2570.70
IV. Medicaid coverable costs paid or unpaid incurred during the eligibility period
The hospital bill for 4/3 through 4/6 ($3500) was not itemized for insurance payments ($1200). To determine the daily portion of the hospital bill the client is responsible for - divide the total insurance payment by the total hospital bill to the 4th decimal place ($1200 ÷ $3500 = .3428).
4/3 Charges
Multiply 4/3 hospital bill by .3428 ($1500 x .3428 = $514.20)
Subtract the result from the 4/3 hospital bill
($1500 – $514.20 = $985.80)
4/3 hospital charge used against the deductible - $ 985.80
Remaining deductible $1584.90
4/4 Charges
Multiply 4/4 hospital bill by .3428 ($1000 x .3428 = $342.80)
Subtract the result from the 4/4 hospital bill
($1000 – $342.80 = $657.20) $ 657.20
Physician’s bill after insurance + $ 65.00
Prescription + $ 46.25
Total charges for 4/4 - $ 768.45
Remaining deductible $ 816.45
4/5 Charges
Multiply 4/5 hospital bill by .3428 ($900 x .3428 = $308.52)
Subtract the result from the 4/5 hospital bill
($1000 – 308.52 = $691.48) $ 691.48
Physician’s bill after insurance + $ 200.00
Radiology services after insurance + $ 400.00
Total charges for 4/5 $1291.48
The charges for 4/5 are greater than the remaining deductible of $816.45.
The applicant met the deductible on 4/5. The first full day of coverage is 4/6.
The applicant is responsible for the remaining deductible of $816.45 and there are a number of bills on 4/5.
To determine the applicant’s share for each provider for bills incurred on 4/5:
I. Divide remaining deductible by total charges for 4/5 to the 4th decimal place.
($816.45 ÷ $1291.48 = .6322)
II. Multiply each provider's bill by .6322. This is the amount the applicant is responsible for.
Hospital $691.48 x. 6322 = $ 437.13
Physician $200.00 x .6322 = $ 126.44
Radiology $400.00 x .6322 = $ 252.88
Applicant responsibility for 4/5 $ 816.45
All costs applied to the deductible must be verified. For each item, with the exception of transportation costs, the applicant must provide a dated bill or receipt showing the name of the provider, date of service, type of service, costs and any insurance payments. If the applicant does not provide an appropriate bill or receipt, the cost cannot be applied.
For transportation, the individual's record must show the reason the cost was incurred, the place visited and the date. A receipt is required if the applicant paid someone else for the transportation. If the applicant's car was used, the actual cost of gas and oil may be calculated or a cost allowed (using current allowance authorized by State Employees Contract). The individual should be given the opportunity to choose whichever option they prefer.
When determining eligibility for the State Supplement only, the individual must comply with Medicaid rules for assignment of rights (See Part 2, Section 6) and residency (See Part 2, Section 4).
When individuals have been denied SSI due to the 8/96 citizenship rules they may be eligible for a State Supplement payment. Upon application to the Department they must meet all other eligibility criteria in this section. This excludes individuals eligible for emergency services only.
State Supplement budgeting rules, found in Part 7, Section 2, are used to determine countable income. The payment is the difference between countable income and the maximum SSI payment plus the State Supplement amount for the living arrangement.
Example:
Barb Doyle is a 70 year old individual who is not eligible for SSI due to 8/96 citizenship rules. She is receiving a pension of $300 and lives in the community.
Her countable income is:
$ 300 Pension
- $ 20 Federal Disregard
- $ 55 State Disregard
$ 225 Countable Income
Her payment amount is:
$ 674 Max SSI payment level (eff. 1/09)
+ $ 10 State Supplement payment level
$ 684
- $ 225 Countable Income
$ 459 Payment Amount
If we know the individual is not eligible for SSI due to citizenship rules described above, there is no need for a separate SSI eligibility determination.
"Substantial Gainful Activity" (SGA) is full or part time work that involves physical or mental activities which are usually done for pay or profit, although there may not be a profit.
Applicants who have average monthly earnings of more than $980 a month are considered to be engaging in SGA. (see Appendix B for calculation of this application pretest).
Applicants who are determined to be engaged in Substantial Gainful Activity are not eligible for State Supplement.
Applicants who have stopped work in the month of application do not have to meet the SGA test. Any income from the terminated employment is countable income.
Recipients who are working must continue to meet the definition of disability.
The following are examples of activities that would not be considered Substantial Gainful Activity:
I. A job is made for an individual out of sympathy or compassion, or which can be performed only because others provide more assistance or supervision than would be characteristic of a bona fide employment situation or a market for the goods or services is created more out of sympathy than intrinsic value received.
II. A job that is part of occupational therapy prescribed and supervised by a physician.
III. An activity which is in the nature of a hobby and does not provide a bona fide job opportunity from the standpoint of genuine economic demand and remuneration.
IV. Activity which is part of an active Vocational Rehabilitation program constituting training and supervised by a rehabilitation agency.
I. For those living alone/with others or residing in a Flat Rate Boarding Homes or Adult Foster Homes, the State Supplement benefit starts the month following the month of application or the month of eligibility, whichever is later.
For example, if an individual applies for and is eligible for SSI in 3/08, the first month for which the SSI and State Supplement benefits are authorized will be 4/08.
II. For Cost Reimbursed Boarding Homes, Adult Family Care Homes and Residential Care Facilities, the State Supplement benefit will be effective the month following the month a decision is made.
For example, if the State Supplement is being authorized on June 2nd, July will be the first month a check is issued.
The amount of the State Supplement benefit depends on an individual's living arrangement.
If an individual is eligible for part of a month, they are eligible for a full month benefit.
Codes used by SSI and adopted for State Supplement use:
A. Individuals in living arrangement A are living alone or with others. This includes an individual living with their ineligible spouse. It also includes minor children living with their parents. Individuals in this living arrangement receive a State Supplement benefit of $10.00. For a couple, the benefit is $7.50 per individual. This amount does not vary. If eligible for a State Supplement, the benefit amount is $10.00/$7.50.
If an individual in this living arrangement is eligible for a Spousal Living Allowance (SLA), see Part 12, Section 5, the Living Allowance is a State Supplement.
* Instead of $10.00, when the individual is getting SSI, the SLA benefit amount is found in Chart 3.8.
* Instead of $10.00, when the individual gets a State Supplement only, the amount of the benefit is determined according to Part 12, Section 5.
B. [Not in use]
C. Individuals in this living arrangement are living in the household of another. They receive a benefit of $8.00. A couple receives $6.00 per person. This benefit amount does not vary. If eligible for a State Supplement, the benefit amount is $8.00/$6.00.
* If an individual in this living arrangement is eligible for a Spousal Living Allowance (see Part 12, Section 5), the Living Allowance is a State Supplement. Instead of $8.00, when the individual is getting SSI, the SLA benefit amount is found in Chart 3.8.
* Instead of $8.00, when the individual gets a State Supplement only, the amount of the benefit is determined according to Part 12, Section 5.
D. Living in a State or Waiver State Adult Foster Home: The maximum benefit is $49.00. If the individual is eligible for SSI, the maximum is authorized. If the individual is over income for the SSI but under income for the State Supplement, the State Supplement will vary depending upon the individual’s countable income.
E. Living in a Flat Rate Boarding Home: These facilities are licensed by the State to provide care for up to six individuals. The maximum benefit for an individual is $217.00. If the individual is eligible for SSI, the maximum is authorized. If the individual is over income for SSI, but under income for the State Supplement, the State Supplement will vary depending upon the individual’s countable income.
F. Living in an Adult Family Care Home: These facilities are licensed by the State to care for up to five people. The maximum State Supplement for individuals is $234.00. If the individual is eligible for SSI, the maximum is authorized. If the individual is over income for SSI but under income for the State Supplement, the State Supplement will vary depending upon the individual’s countable income.
G. Living in a Cost Reimbursed Boarding Home. These facilities are licensed by the State to care for seven or more individuals. The maximum State Supplement benefit for an individual in this living arrangement is $234.00. If the individual is eligible for SSI, the maximum is authorized. If the individual is over income for SSI but under income for the State Supplement, the State Supplement will vary depending upon the individual’s countable income.
H. Living in a medical institution: Residing in a medical institution means that the individual is living there for more than thirty consecutive days and is expected to remain. The State Supplement for individuals in this living arrangement is $10.00. For a couple, it is $20.00. This amount does not vary.
I. Residential Care Facility: These facilities are licensed by the State to care for seven or more individuals. The State Supplement benefit is $10.00. For a couple the benefit is $7.50 per individual. The amount does not vary.
For those in living arrangements A/C/H, the benefit amount is fixed. Once the individual is eligible for the State Supplement, they get the appropriate State Supplement benefit.
For living arrangements D/E/F/G, the amount of the State Supplement will vary with countable income when the individual is not eligible for SSI. When is eligible for SSI, the individual receives the maximum State Supplement amount.
If an individual is receiving a State Supplement in one living arrangement and moves to a different arrangement, any increase in benefit will be made effective the month the individual is in the new living arrangement up to three months retroactive to the month the move is reported to the Department.
Any decrease in benefits will be given timely notice of adverse action.
For example, the individual moves from a Cost Reimbursed Boarding Home to his own home and reports this on 7/2. The August State Supplement payment will be reduced to $10.00. If this had been reported on 7/22, the September payment would be reduced to $10.00.
When the individual is receiving a State Supplement and SSI and the SSI is subsequently closed, the State Supplement payment will be ended unless the individual is eligible for a State Supplement only payment or the SSI closing is timely appealed with SSI and the individual meets all other eligibility rules.
A Representative Payee for an SSI or SSA payment may be used for the State Supplement check.
If not receiving an SSI or SSA benefit, the State Supplement check may be received by other than the individual if that person is the individual’s legal guardian, conservator or has power of attorney.
When an individual reports a check has been lost, stolen or destroyed prior to cashing, the agency has the responsibility to replace it. In the instances when there is reason to believe there has either been a forgery or duplicate checks have been received and cashed by the recipient, the following procedures have been established.
I. Forgeries
When the photocopy of the original check is sent to the OFI office, staff must meet face-to-face with the individual or Representative Payee to determine whether or not the signature is theirs. If the individual or Representative Payee states it is not, then a Forgery Affidavit will be completed (SWIM-052) and the original sent to FIR with a copy to Division of Financial and Personnel Services and a copy for the record. This initiates an investigation to determine who cashed the check.
If the individual or Representative Payee agrees that the signature on the original check is theirs, OFI staff may refer for fraud.
II. Replacing a Check
When a household presents a damaged check, which a bank refuses to cash, the worker will take the following steps:
A. Complete a SWIM-050 (Stop Payment).
B. Complete a SWIM-051 (Application for a Duplicate Check).
C. Void the damaged check.
D. Forward the original forms and the damaged check to the Division of Financial and Personnel Services. A copy is retained for the record.
When expended using an Electronic Benefits Transfer (EBT) card, State Supplement benefits are subject to the same purchase restrictions as those described in 22 M.R.S. §3763(11) and 10-144 C.M.R. 331, Ch. VI, governing Temporary Assistance for Needy Families (TANF) benefits. These restrictions do not apply to federal SSI benefits. When the recipient chooses to have funds distributed to them as direct deposit or check, State Supplement benefits are not subject to the above purchase restrictions.
Adult Foster Home (AFH):
Each AFH usually serves one to three individuals who are usually being served by the Office of Aging and Disability Services (OADS). OADS groups AFH into:
* Private AFH or “Foster Waiver Homes” where residents are also enrolled in the OADS Home & Community Based Waiver Program, and
* State Assisted AFH where residents are enrolled in SSI/State Supplement and/or OADS Home & Community Based Waiver Program. This distinction is used for OADS purposes only. Medicaid eligibility is determined using the same rules for all AFH but the State Supplement amount is different for each group (See Part 11 for information on the State Supplement).
Flat Rate Boarding Home (FRBH)
Each FRBH usually serves up to five individuals who are usually being served by OADS.
Cost Reimbursed Boarding Home (CRBH)
CRBH serve six or more individuals. These facilities are classified as Private Non-Medical Institutions (PNMI).
Residential Care Facility (RCF)
RCF serve six or more individuals. These facilities are classified as Private Non-Medical Institutions (PNMI).
Adult Family Care Home (AFCH)
AFCH serve up to five individuals. Residents of AFCH receive a greater level of care than is provided in a CRBH or RCF but less than that provided in a nursing facility. These facilities are classified as a Private Non-Medical Institutions (PNMI).
Eligibility for coverage requires that the individual:
* has a coverable group.
* meets asset criteria.
* meets income criteria
For individuals residing in a CRBH, RCF, or AFCH above it is necessary to determine the amount that the individual is expected to pay toward the cost of their care if they are found to be eligible for coverage.
For all living arrangements individuals must have a Medicaid coverable group. This can be any coverable group including Non-Categorical. The individual need not be in an elderly or disability coverage group.
For all living arrangements, when determining eligibility for Medicaid “countable assets” are assets after exclusions (see Part 16).
For all facilities in this Part, countable assets must be under $2000 for an individual or $3000 for a couple.
Countable assets, exclusions and deductions are identified in Part 16. Apply these rules based on the coverable group the individual is in.
Transfer of asset rules found in Chapter 336 of this Manual apply to individuals residing in a CRBH, RCF, or AFCH.
For all living arrangements, when determining eligibility for Medicaid “countable income” is gross income minus exclusions (See Part 17) and disregards (See Part 7, Section 2.1 ).
Section 4.1: Adult Foster Homes (AFH)
Residents are considered to be individuals ‘living with others”. If a married couple resides in the facility, at the option of the couple, eligibility may be determined as a couple if either member of a couple is not eligible when treated as an individual. The countable income of each spouse is totaled. Each spouse is deemed to receive one-half of this total and each is compared to 100% FPL.
I. If countable income is under the income limit for SSI/State Supplement the individual needs to apply for SSI/State Supplement in order to get help with their costs for residing in the AFH. When eligible for SSI/State Supplement, Medicaid coverage is also provided.
Note: Residents of “State Assisted” AFH are potentially eligible for a $49.00 State Supplement. Residents of “Private AFH” are potentially eligible for $10.00 State Supplement.
II. If countable income is equal to or over the State Supplement income limit for this living arrangement the individual is eligible for Medicaid if countable income is equal to or under 100% FPL.
III. If countable income is over 100% FPL the individual may be eligible for Medicaid under Medically Needy (See Part 10).
IV. If countable income is over 100% FPL and the individual is applying for a Home and Community Based Waiver Program (See Part 13), Medicaid eligibility is determined using the rules of that program.
Section 4.2: Flat Rate Boarding Homes (FRBH)
Residents of FRBH are considered to be individuals “living with others”. If a married couple resides in the facility, at the option of the couple, eligibility may be determined as a couple if either member of a couple is not eligible when treated as an individual. The countable income of each spouse is totaled. Each spouse is deemed to receive one-half of this total and each is compared to 100% FPL.
I. If countable income is under the income limit for SSI/State Supplement the individual needs to apply for SSI/State Supplement in order to get help with their costs for residing in the FRBH. When eligible for SSI/State Supplement, Medicaid coverage is also provided.
II. If countable income is equal to or over the State Supplement income limit for this living arrangement the individual is eligible for Medicaid if countable income is equal to or under 100% FPL.
III. If countable income is over 100% FPL the individual may be eligible for Medicaid under Medically Needy (See Part 10).
IV. If countable income is over 100% FPL and the individual is applying for a Home and Community Based Waiver Program, Medicaid eligibility is determined using the rules of that program (See Part 13).
Section 4.3: Cost Reimbursement Boarding Homes (CRBH), Residential Care Facilities (RCF) and Adult Family Care Homes (AFCH)
Residents of these facilities are considered to be individuals “living with others”. If a married couple resides in the facility, at the option of the couple, eligibility may be determined as a couple if either member of a couple is not eligible when treated as an individual. The countable income of each spouse is totaled. Each spouse is deemed to receive one-half of this total and each is compared to the private rate for the CRBH and RCF or the income limit in Chart 3.9 for AFCH.
I. If countable income is under the income limit for SSI/State Supplement the individual needs to apply for SSI/State Supplement in order to get help with the cost of their care. When eligible for SSI/State Supplement, Medicaid coverage is also provided.
II. If countable income is equal to or over the State Supplement income limit for this living arrangement, the individual is eligible for coverage if countable income is equal to or under the thirty-one day private rate for the CRBH and RCF, or the income limit in Chart 3.9 for the AFCH in which they reside.
III. If countable income is over the private rate, the individual may become eligible if they meet a deductible (See Part 10 for the rules on Medically Needy).
Medical services provided by the facility are medical costs incurred by the individual. They are used before other medical expenses to determine if the individual meets the deductible. These medical services are projected over a six month period. They are identified by the Office of MaineCare Services and are
assigned a daily rate (cost). The daily rate is multiplied by thirty-one days to determine the monthly amount.
IV. If countable income is over 100% FPL and the individual is applying for a Home and Community Based Waiver Program (See Part 13), Medicaid eligibility is determined using the rules of that program. The rules in this section are used to determine the cost of care. The cost of care is paid to the facility.
Section 4.3.1: Determining the Cost of Care for an Individual
I. A cost of care or assessment is determined for all individuals. The cost of care is the monthly amount the individual is expected to contribute toward the cost of his/her care in the facility.
II. The individual has a zero cost of care for the month they are admitted to the facility. There is a cost of care for the month of discharge.
III. Cost of Care for an Individual
A. Determine gross monthly income. Total gross monthly income includes the State Supplement benefit:
1. If the individual has elected an option under his or her retirement plan that results in a reduced benefit to the individual in exchange for a continued benefit to the spouse upon the individual’s death, (e.g. a joint and survivor annuity option), then that reduced amount will be considered to be gross income. However, the reduced amount may be used only if both the election is irreversible and the reduction amount does not exceed $1,000 per month.
2. If income is garnished due to a court order for child support the reduced amount of the income is used. The maximum reduction allowed is up to and including $1,000 per month per child.
B. From total gross monthly income, subtract:
1. Earned income disregard (See Part 7, Section 2.1),
2. Current federal, state or local income tax deductions,
An adjustment may be made if there are current federal, state or local income tax deductions from the individual’s gross income. Usually the amount of taxes withheld will be based on the previous year's income tax return. The adjustment for taxes cannot exceed the current tax liability. A deduction for past due taxes is not allowed.
Examples
* Last year $600 was the tax liability. $80.00 per month is withheld for income tax. Only $50.00
per month can be allowed as a deduction as this is the current tax liability ($600 ÷ 12 = $50.00).
* Last year $600 was the tax liability. $25.00 per month is being withheld for income tax. A deduction of $50.00 per month is allowed as a deduction as this is the current tax liability ($600 ÷ 12 = $50.00).
Note: If an individual is paying estimated quarterly taxes, use these for an adjustment in the gross income. The procedure is the same as if the taxes were being withheld.
3. $70 (personal needs and federal disregard);
4. Medicare premium for the individual;
5. HUD Standard - The HUD Standard is a monthly subsidy given to a facility by the Department of Housing and Urban Development on behalf of residents of the facility; and
6. health insurance premiums incurred by the individual for the individual and/or the individual’s spouse if the spouse is covered by Medicaid and is residing in a CRBH, RCF, Nursing Facility or covered by a Home and Community Based Waiver,
Premiums must be incurred by the individual residing in the specified facility. If the health insurance is provided by the individual’s spouse through his/her coverage, this is not considered to be a cost incurred by the individual who resides in a facility. It is a cost incurred by the individual’s spouse.
Note: Indemnity insurance premiums are not deducted. They are policies that pay for lengths of stay or for a condition and not for specific services. Third Party Liability should be contacted to assess cost effectiveness. If cost effective TPL will arrange for premium payment.
C. The result is the cost of care.
Note: If there is a partial month transfer of asset penalty, the individual may be responsible for an amount in addition to his or her cost of care (see Chapter 336 of this Manual).
Section 4.3.2: Determining the Cost of Care for a Couple
I. Determine gross monthly income of the couple. Total gross monthly income includes the State Supplement benefit.
A. If the individual has elected an option under his or her retirement plan that results in a reduced benefit to the individual in exchange for a continued benefit to the spouse upon the individual’s death, (e.g. a joint and survivor annuity option), then that reduced amount will be considered to be gross income. However, the reduced amount may be used only if both the election is irreversible and the reduction amount does not exceed $1,000 per month.
B. If income is garnished due to a court order for child support the reduced amount of the income is used. The maximum reduction allowed is up to and including $1,000 per month per child.
II. From total gross monthly income, subtract:
A. Earned income disregard (Part 7, Section 2.1);
B. Current federal, state or local income tax deductions;
An adjustment may be made if there are current federal, state or local income tax deductions from the individual’s gross income. Usually the amount of taxes withheld will be based on the previous year's income tax return. The adjustment for taxes cannot exceed the current tax liability. A deduction for past due taxes is not allowed. tax return. The adjustment for taxes cannot exceed the current tax liability. A deduction for past due taxes is not allowed.
Examples
* Last year $600 was the tax liability. $80.00 per month is withheld for income tax. Only $50.00 per month can be allowed as a deduction as this is the current tax liability ($600 ÷ 12 = $50.00).
* Last year $600 was the tax liability. $25 per month is being withheld for income tax. A deduction of $50 per month is allowed as a deduction as this is the current tax liability ($600 ÷ 12 = $50.00).
Note: If an individual is paying estimated quarterly taxes, use these for an adjustment in the gross income. The procedure is the same as if the taxes were being withheld.
B. $120 (personal needs and federal disregard);
C. Medicare premium for the individual;
D. HUD Standard - The HUD Standard is a monthly subsidy given to a facility by the Department of Housing and Urban Development on behalf of residents of the facility; and
E. health insurance premiums incurred by either or both spouses for either or both spouses.
Note: Indemnity insurance premiums are not deducted. They are policies that pay for lengths of stay or for a condition and not for specific services. Third Party Liability should be contacted to assess cost effectiveness. If cost effective TPL will arrange for premium payment.
III. Divide the result by two. The result is the cost of care for each spouse.
Note: If there is a partial month transfer of asset penalty, the individual may be responsible for an amount in addition to his or her cost of care (see Chapter 336 of this Manual).
Section 4.3.3: Determining the Cost of Care for an Individual or Couple open on SSI
For an individual or a couple receiving only an SSI benefit, the cost of care is the maximum SSI and State Supplement benefit for an individual/couple (see Chart 3.6) minus the following deductions:
Personal needs of $50.00 for an individual/$100 for a couple;
health insurance premiums incurred by the individual for the individual and/or the individual’s spouse if the spouse is covered by Medicaid and is residing in a CRBH, RCF, Nursing Facility or covered by a Home and Community Based Waiver
the HUD Standard - The HUD Standard is a monthly subsidy given to a facility by the Department of Housing and Urban Development on behalf of residents of the facility.
For an individual or a couple open for an SSI benefit and receiving another income, the cost of care is determined by deducting the following from gross monthly income:
Personal needs of $50.00 for an individual/$100 for a couple;
Federal Disregard of $20.00 for those with income in addition to SSI/State Supplement as long as their income is not based on need (for example, VA pension does not get this disregard, but VA compensation does);
health insurance premiums incurred by the individual for the individual and/or the individual’s spouse if the spouse is covered by Medicaid and is residing in a CRBH, RCF, Nursing Facility or covered by a Home and Community Based Waiver; and
the HUD Standard - The HUD Standard is a monthly subsidy given to a facility by the Department of Housing and Urban Development on behalf of residents of the facility.
Section 4.3.4: Changes in the cost of care are made in the following situations
I. The individual paid a cost of care that was more than what was actually due. When this was due to Department error, the individual cost of care is adjusted retroactively up to one year from the date the error is discovered by the Department. When this was due to error by the individual, no adjustment is made.
II. The individual paid a cost of care that was less than what was actually due. Whether this is due to error by the Department or the individual, the individual’s cost of care is adjusted retroactively up to three months from the date the error is discovered by the Department without advance notice. This includes an adjustment for a lump sum payment.
I. A spousal living allowance can be given to the spouse of an individual who is residing in a Cost Reimbursed Boarding Home (CRBH)/Adult Family Care Home AFCH)/Residential Care Facility (RCF).
II. In this section, the term “individual” refers to the spouse residing in a CRBH, AFCH, or RCF. The term “at home spouse” refers to the spouse applying for or receiving the spousal living allowance. The “at home spouse” must be legally married under State of Maine law to the individual.
III. When an individual is getting help from Medicaid with their expenses in a CRBH, AFCH, or RCF, the at home spouse may be eligible for a spousal living allowance. This is a payment that is made directly to the at home spouse.
The living allowance starts the month of application by the at home spouse or the first full calendar month the individual is residing in a CRBH, AFCH, or RCF, whichever is later.
Example
The at home spouse applies in 10/08 but 11/08 is the first full calendar month his/her spouse is residing in a Residential Care Facility. 11/08 is the first month of payment.
IV. An application is considered to be filed for the living allowance when:
A. the individual residing in the CRBH/AFCH/RCF files an application for help to pay for their residential care expenses or;
B. the at home spouse requests a spousal living allowance and s/he is receiving assistance through the Food Supplement Program, Medicaid, SSI or the State Supplement.
If none of the above applies, the at home spouse must file a separate application with OFI.
Section 5.1: Eligibility
I. Non-Financial Criteria
A. The at home spouse must be living alone or with others (living arrangement A) or living in the household of another (living arrangement C). The spouse cannot be living in a residential care facility or medical institution. Living arrangements are further defined in Part 11, Section 5.
B. If the at home spouse is not otherwise covered by Medicaid s/he must meet the basic eligibility requirements identified in Part 2 regarding citizenship, residency and providing a Social Security Number.
C. The at home spouse does not need to meet the SSI - Related rule of being aged, blind or disabled.
II. Financial Criteria
A. countable assets must be less than $2,000. The rules on treatment of assets are the same as the SSI - Related rules that are outlined in Part 7, Section 1 and Part 16;
B. countable income of the at home spouse must be less than 100% of the Federal Poverty Level for one; and
C. countable income is determined using the SSI - Related rules that are identified in Part 7, Section 2 and Part 17.
Section 5.2: Benefits
I. The at home spouse may be eligible for a payment of up to 100% of the Federal Poverty Level for one. There are no partial month benefits. If eligible for part of the month, then benefits will be authorized for the entire month.
A. If the at home spouse is receiving an SSI payment, the monthly living allowance for SSI recipients is the amount listed in Chart 3.8. This amount is authorized in place of the $10.00/$8.00 State Supplement and is considered a State Supplement.
B. If the at home spouse is receiving the State Supplement only (not SSI) the living allowance will be the difference between countable income and 100% of the Federal Poverty Level for one. This will be authorized in place of the $10.00/$8.00 State Supplement and is considered a State Supplement.
C. If the at home spouse is receiving Medicaid but not SSI or State Supplement, the living allowance will be the difference between the spouse’s countable income and 100% of the Federal Poverty Level for one.
D. If the at home spouse is not receiving SSI, State Supplement or Medicaid, the living allowance will be the difference between the spouse’s countable income and 100% of the Federal Poverty Level for one.
Example
Mr. Komart enters a Residential Care Facility in 7/08. Mrs. Komart meets all non-financial and financial rules to receive a spousal living allowance effective 8/08. Her only income is Social Security Retirement of $775 monthly. Her spousal living allowance is determined as follows:
Step 1 $ 775 (gross income)
- $ 20 (federal disregard)
- $ 55 (state disregard)
$ 700 (countable income
Step 2 $ 867 (100% FPL for one)
- $ 700 (countable income)
$ 167 (spousal living allowance)
II. The Spousal Living Allowance continues as long as the at home spouse is financially and otherwise eligible and as long as s/he has a spouse residing in a CRBH, AFCH, or RCF who is being helped with their expenses by Medicaid.
Individuals can get Medicaid coverage and special services if they meet the medical and financial requirements of one of the following coverage groups:
I. Home and Community Benefits for the Elderly and for Adults with Disabilities Waiver: This is for individuals (age 18 or older) who meet nursing facility level-of-care requirements and choose to remain at home. Some of the services include: care coordination, personal support services, home health services, adult day health services, transportation, emergency response system, environmental modifications and respite services. The program rules are in Section 19 of the MaineCare Benefits Manual, (10-144 CMR Chapter 101)
II. Support Services for Members with Intellectual Disability or Autistic Disorders: This benefit provides support services to members who most commonly live on their own or with families; there are occasionally individuals living in group homes who are also eligible. The major support services are community support and work support. This waiver does not provide any residential services. The program rules are in the MaineCare Benefits Manual, Section 29.
III. Home and Community Benefits for Members with Intellectual Disabilities or Autistic Disorder Waiver: This waiver offers a comprehensive mix of services to members age 18 or older. The major services offered are: home support—including support to live alone or in settings with others (i.e. group homes), community support, and work support. The program rules are in the MaineCare Benefits Manual, Section 21.
These individuals are residing in the community, and have been classified as needing nursing facility level-of-care requirements or meeting the ICF-IID level of care.
IV. Home and Community Based Waiver Benefit for Children with Intellectual Disabilities and/or Pervasive Developmental Disorders (ID and/or PDD): This waiver provides an alternative to institutional care to children aged five through twenty with ID and /or PDD who would otherwise require services in an ICF-IID or a psychiatric hospital. The services offered through this waiver and other program rules are specified in the MaineCare Benefits Manual, Section 32.
V. Home and Community Based Waiver Benefit for Adults with Other Related Conditions Aged 21 and Over: This waiver provides an alternative to institutional care to adults aged 21 and older with a “related condition,” as defined at 42 C.F.R. §435.1010. The services offered through this waiver and other program rules are specified in the MaineCare Benefits Manual, Section 20.
VI. Home and Community Based Waiver Benefit for Adults with Brain Injury: This waiver provides an alternative to institutional care to adults aged 18 and older with brain injury. The services offered through this waiver and other program rules are specified in the MaineCare Benefits Manual, Section 18.
An individual eligible for waiver may live with family members eligible for community MaineCare. The waivered individual’s income and assets are used in the eligibility determination for the remaining family members.
Example
Mr. Clooney lives with his wife, Wendy. They meet SSI - Related criteria as a married couple. Mr. Clooney’s eligibility for community MaineCare will be based on the combined income and resources of the couple, with an income limit for a household of two. Wendy’s eligibility for waiver services is based on income and resources owned solely by her.
Eligibility for the Medicare buy-in is determined using community rules for a couple. Eligibility for waiver does not affect how the Medicare Buy-In is determined.
Individuals applying for Waivers must have a coverable group.
Individuals must be eligible for nursing facility, ICF-IID, or psychiatric hospital level of care, depending on the medical criteria of the specific waiver program. This determination is done by the Department of Health and Human Services or a designated agency.
The waivered individual's assets must not exceed the SSI - Related asset limit for an individual (See Part 7, Section 1).
Countable assets are defined in Part 16 with the following exceptions:
I. Assets of a non-waivered spouse are not deemed when determining eligibility for the spouse applying for the Waiver as of the first day of the month in which the individual is considered to be in nursing facility or ICF-IID level care status.
II. Assets that are owned jointly are considered wholly owned by the waivered individual.
III. If both eligible individuals are in a waiver status, the asset limit is $2000 for each.
IV. There is no computation of the community spouse's protected share of assets.
Section 4.1: Transfer of Assets
Transfers by the individual or their spouse may be subject to a penalty. Follow the procedures outlined in Part 15. Individuals who are Medicaid eligible under the following coverage groups are not subject to the transfer of asset penalty:
I. any MAGI-based group;
II. an SSI - Related group with an income limit of 100% FPL.
Income guidelines for individuals under the Waiver Programs follow the definitions in Part 17 with the following exceptions:
I. Gross income of an individual must be less than or equal to the Categorical Nursing Care limit (See Chart 4.1). If income exceeds this amount, determine eligibility using the Medically Needy process in Part 10.
II. There is no deeming of income from the non-waivered spouse.
III. If the income of the individual is being reduced due to previous overpayments by government agencies, the reduced payment amount is used.
IV. VA pensions that are Aid and Attendance or based on unusual medical expenses are not counted as income.
A cost of care is determined for any month in which eligibility exists.
Cost of care is determined by the budgeting process for that waiver and paid to the appropriate agency.
The cost of care is due for each month for which services are provided even if services are not provided for a full calendar month.
The cost of care may be adjusted without timely notice and may be adjusted retroactively (See Part 14, Section 6.2).
Individuals who are Medicaid eligible under the following coverage groups do not have a cost of care:
I. any MAGI-based group;
II. an SSI - Related group with an income limit of 100% FPL.
Note: If there is a partial month transfer of asset penalty the individual may be responsible for an amount in addition to their cost of care (See Part 15, section 1.8).
Section 6.1: Budgeting
Note: VA pensions that are Aid and Attendance or based on unusual medical expenses are not used to determine the cost of care in the Home and Community Based Waivers.
I. Determine the individual's gross monthly income. If this figure is over the Categorical Nursing Care limit (see Chart 4.1), use the SSI-Related budget for an individual (Part 7) and the deductible process (Part 10) to determine eligibility.
Once the individual is Medicaid eligible, use the following steps to determine the individual’s cost of care.
A. If the individual has elected an option under his or her retirement plan that results in a reduced benefit to the individual in exchange for a continued benefit to the spouse upon the individual’s death (e.g. a joint and survivor annuity option), then that reduced amount will be considered to be gross income. However, the reduced amount may be used only if the election is irreversible and the reduction amount does not exceed $1,000 per month.
B. If income is garnished due to a court order for child support the reduced amount of the income is used. The maximum reduction allowed is up to and including $1,000 per month, per child.
C. An adjustment may be made if there are current federal, state or local income tax deductions from the individual’s gross income. Usually the amount of taxes withheld will be based on the previous year's income tax return. The adjustment for taxes cannot exceed the current tax liability. A deduction for past due taxes is not allowed.
Examples
1. Last year $600 was the tax liability. $80.00 per month is withheld for income tax. Only $50.00 per month can be allowed as a deduction as this is the current tax liability ($600 ÷ 12 = $50.00).
2. Last year $600 was the tax liability. $25.00 per month is being withheld for income tax. A deduction of $50.00 per month is allowed as a deduction as this is the current tax liability
($600 ÷ 12 = $50.00).
Note: If an individual is paying estimated quarterly taxes, use these for an adjustment in the gross income. The procedure is the same as if the taxes were being withheld.
D. When a husband and wife are living together and are both covered by a Waiver, they each may have a cost of care. However, they may allocate income to each other to reduce or eliminate the cost of care.
Example
Husband and wife are both eligible for Waiver. The husband has SSA of $1,400. The wife has SSA of $700. We allocate $350 to the wife so each will have $1,050 used in the calculation of their individual costs of care.
II. Subtract 200% Federal Poverty Level for a single-person household. This is the Personal Needs Allowance for the individual.
III. Subtract the cost of:
A. Medicare payments for the individual.
B. Health insurance premiums incurred by the individual for the individual and/or the individual’s spouse if the spouse is covered by Medicaid and is residing in a CRBH, RCF, AFCH, Nursing Facility or covered by a Home and Community-Based Waiver.
Notes
Premiums must be incurred by the Medicaid recipient. If the health insurance is provided by the non-waivered spouse through his/her coverage, this is not considered to be a cost incurred by the Medicaid recipient. It is a cost incurred by the non-waivered spouse.
Indemnity insurance premiums are not allowed. These are policies that pay for length of stay or a condition but not for a specific service. Third Party Liability should be contacted to assess cost effectiveness. If cost-effective, TPL will arrange for premium payment.
C. Certain Medical Expenses
1. Unpaid medical expenses incurred by the individual for necessary medical services. This includes payment on the unpaid balance of a loan taken out to pay for medical expenses incurred prior to Medicaid coverage provided the proceeds of the loan were used to pay the medical bill. Only the amount of the loan actually used to pay the medical bill may be deducted and only the principal (and not the interest) part of the unpaid balance may be used as a deduction.
2. Disability related expenses that are not payable by the waiver, the Medicaid program, or a third-party payer. Disability related expenses include:
a. Home access modifications: ramps, tub/shower modifications and accessories, power door openers, shower seat/chair, grab bars, door widening.
b. Communication devices: adaptations to computers for communication or environmental control, speaker telephone, teletext devices.
c. Wheelchair (manual or power) accessories: accessories, lab tray, seats and back supports.
d. Adaptations to transportation vehicles: adapted carrier and loading devices, one communication device for emergencies (limited to purchase and installation), adapted equipment for driving.
e. Hearing aids.
f. Glasses and adapted visual aids.
g. Environmental control units: devices that substitute for touch control such as a voice activated device to adjust lighting.
h. Assistive animals (purchase only).
i. Personal emergency response systems.
3. A medical expense or disability related expense will not be deducted from the cost of care if:
a. the expense was covered by insurance (including Medicare).
b. the expense was not covered due to a Medicaid penalty period of ineligibility.
c. the Department has determined that the expense was not the responsibility of the individual because a medical assessment was not timely and requested by the facility or because the facility did not timely and adequately assist the individual with filing a Medicaid application. This determination is made by the Office of Aging and Disability Services (OADS).
d. the expense is the cost of care to a medical institution or a waiver agency during periods of Medicaid coverage.
e. the expense was for a Medicaid covered service and the individual was covered by Medicaid.
4. Verified medical expenses are deducted from the cost of care in the month following the month in which the bills are received in the regional office.
IV. Subtract any spousal allocation. To determine this:
A. Determine the spouse's gross monthly income, including SSI and TANF payments.
B. Subtract the gross monthly income from the maximum spousal allowance (see Chart 4.2).
C. The balance is the spousal allocation.
V. Subtract any dependent allocation. When an individual eligible under the Waivers has dependents living at home, an allocation may be allowed for their needs. For purposes of this section, a dependent is defined as a minor or dependent child, dependent parents, or dependent siblings of the waivered individual or non-waivered
spouse. These dependents are individuals who may be claimed for tax purposes under Internal Revenue Code. To determine the allocation:
A. determine the dependent(s) gross monthly income, including SSI and TANF payments.
B. subtract the gross monthly income from the appropriate maximum dependent allowance (See Chart 2). The balance is the dependent allocation.
VI. The remainder is the individual's cost of care.
Example
Don Renoir is 75 years old. He has applied for the Elderly Waiver. Assets in his name only are under $2,000. He receives Social Security and a pension totaling $1,500 per month.
His spouse, Claudette, has Social Security of $500 per month.
The 19-year old son, who is the couple’s dependent, lives with them. He has zero monthly income.
$1,500.00 Mr. Renoir’s gross monthly income
- 1,945.00 personal needs allowance for Mr. Renoir (200% of FPL)
$ -445.00
- 96.40 Medicare Part B premium
$ Not applicable
- 123.00 spousal allocation
$ not applicable
- 154.00 dependent allowance
$ 0.00 Mr. Renoir’s cost of care
Spousal allocation is determined as follows:
$ 623.00 maximum spousal allocation
- 500.00 spouse’s gross income
$ 123.00 spousal allocation
Dependent allocation is determined as follows:
$ 154.00 maximum dependent allowance
- 0.00 income of Mr. Renoir’s son
$ 154.00 dependent allocation
Institutionalization: A person is considered institutionalized when he/she resides in a hospital or nursing facility and is expected to remain for thirty consecutive days. A hospital is one that is primarily for the care and treatment of patients with disorders other than tuberculosis or mental disease.
Individuals who die prior to the end of the thirty day period are considered to be institutionalized.
Special income and asset rules are triggered for the person who is institutionalized. These special rules are effective on the first day of the month in which the thirty days of institutionalization starts.
Example
The individual enters a hospital or nursing facility on March 20th and remains for at least thirty consecutive days. Special income and asset rules are effective March 1st.
Section 1.1: Special income and asset limits
The special income and asset limits for institutionalization are as follows:
I. Residing in a Hospital
A. Gross income of the individual must be equal to or less than the Categorically Needy Income Limit in Chart 4.1. If the individual’s gross income exceeds the Categorically Needy Income Limit in Chart 4.1, eligibility is determined using Medically Needy rules. See Part 7.
B. Countable assets of the individual must be under $2,000. If there is a community spouse, the Community Spouse Share of Assets is determined as defined in Section 4.3 of this Part.
C. The cost of care for the individual starts in the first full calendar month residing in a hospital. If there is a community spouse, a Community Spouse Monthly Income Allowance and Income Allocation is determined, as defined in this Part.
II. Residing in a Nursing Facility or skilled section of a hospital
A. Gross income of the individual must be less than the private rate for a semi-private room in the facility where the individual resides. If the income of the individual is over the Categorically Needy Income Limit in Chart 4.1 but under the private rate for the facility, a deductible must be met (See Section 5 of this Part).
B. Countable assets of the individual must be under $2,000. If there is a community spouse, the Community Spouse Share of Assets is determined as defined in Section 4.3 of this Part.
C. The cost of care for the individual starts in the first full calendar month they reside in a nursing facility or skilled level of care. Cost of care is determined as defined in this Part.
If there is a community spouse, a Community Spouse Monthly Income Allowance and Income Allocation is determined, as defined in Section 6.1.1 of this Part.
D. If the gross income of the individual exceeds the private rate for a semi-private room in the facility where the individual resides:
1. the individual may be eligible under Medically Needy, but no nursing care costs are covered;
2. a Community Spouse Asset Allocation is given (See Section 4.3 of this Part); and
3. no cost of care is determined and as a result no Community Spouse Monthly Income Allowance is given.
Individuals applying for nursing facility coverage must have a Medicaid coverable group. This can be any coverable group including Family - Related. The individual need not be in an elderly or disability coverage group.
If the individual only qualifies for a coverage group that does not pay for nursing care services the individual is not given a cost of care since nursing care services are not being paid. This includes Non-Categorical, HIV Waiver and Breast and Cervical Cancer groups (See Part 9).
In order for Medicaid to pay for nursing facility care the person must be in medical need of that level of care. This decision is made by the Department of Health and Human Services or its designee.
Section 3.1: Individuals ineligible due to a transfer of assets
If the individual meets the medical need criteria but is ineligible for help with long term care costs due to a transfer of assets, the Categorically Needy Income Limit in Chart 4.1 is used to determine Medicaid eligibility.
Section 3.2: Individuals who are not in need of nursing facility level of care
I. If an individual in a Nursing Facility does not meet the medical need criteria, that person may still be eligible for Medicaid coverage if the individual would be eligible if they were living in the community. Coverage is determined using the rules in Parts 6, 7 and 10 for an individual in the living arrangement, "living alone or with others". In this situation, Medicaid will not pay for nursing care costs nor can they be used toward meeting a deductible.
II. Awaiting Placement for Residential Care (DAP or APRC). If an individual is in need of residential care but there are no beds available the individual may remain in the nursing facility as awaiting placement to a residential care facility. This coverage is for individuals converting from private pay including Medicare to Medicaid and found not in need of nursing facility level of care. MaineCare may help the individual with the cost of care if they meet eligibility criteria below. The Office of MaineCare Services sets the APRC rates (Chart 3.8).
A. The Office of Aging and Disability Services (OADS) must establish that the individual meets non-financial criteria as identified in the MaineCare Benefits Manual.
B. The following financial criteria must be met:
1. the asset and all non-financial criteria are the same as for an individual residing in a Residential Care Facility (RCF). See Part 12;
2. countable income is determined using the same rules as for an individual residing in a RCF; and
3. the individual's countable income must be less than the APRC amount. A cost of care to be paid to the nursing facility is determined using the same rules as for an individual in a RCF. SSI and State Supplement benefits are counted when determining the cost of care.
If countable income is equal to or over the APRC amount, the daily rate can be used as the cost incurred for medical expenses in determining a “spend-down” (deductible).
C. If countable income is equal to or less than the Community Medicaid income limit for the individual’s coverable group, they can get Medicaid coverage in addition to help with the cost of room and board under APRC.
D. If countable income is over this amount, but less than the APRC amount, the individual is eligible for APRC only (not Medicaid).
E. Coverage under APRC ends when:
1. the Office of Aging and Disability Services (OADS) determines the individual no longer meets the non-financial criteria as identified in the MaineCare Benefits Manual; or
2. the individual becomes financially ineligible.
Individuals must use their assets to meet their needs. Specific types and amounts may be retained by the individual and community spouse to meet current and future needs.
All available assets are to be used in determining eligibility. Countable assets are defined in Part 16. Asset limits are defined in Part 7, Section 1.
Unless exempt, a transfer of assets by the individual is subject to a penalty. Refer to Part 15 to assess if a transfer has occurred and if a penalty needs to be applied.
Countable assets of the individual must be under $2000 on any day of the month for which eligibility is determined.
Section 4.1: Long Term Care Partnership Program
This program provides incentives to Maine’s citizens to purchase long term care insurance by disregarding some assets of the person, if they must apply for financial assistance for help with their long term care needs.
I. Insurance Policy
A. To meet the requirements of this MaineCare program, the long term care insurance policy must be a qualified State long term care insurance partnership as certified by the Maine Bureau of Insurance. Certification requires several factors which include:
1. The policy must cover an insured who was a Maine resident when coverage became effective under the policy. If the individual has a long term care partnership policy from another state which also participates in this program and has agreed to provide reciprocal disregards for Medicaid applicants with qualified partnership plans, Maine will provide the same disregards. The individual must still otherwise qualify for MaineCare assistance as detailed in subsections II and III of this section.
2. The policy must meet the definition of a qualified long term care insurance policy in the IRS Code §7702B(b) and 26 U.S.C. §7702B(b), and must meet the Model regulations specified in 42 USC §1396p(b)5.
3. the policy must have been issued or re-issued on or after July 1, 2009 (the effective date of the applicable approved State Plan Amendment.
4. the policy must meet consumer protection standards of inflation protection, and its issuers are subject to training requirements of the Bureau of Insurance (Maine Bureau of Insurance Regulations 02031 CMR chapter 425).
B. Prior to making application for MaineCare the individual must have used the available coverage and benefits under the approved Long Term Care Policy.
II. Eligibility for MaineCare
A. All non-financial eligibility requirements as detailed in Section 1000 of this manual must be met.
B. Applicant must meet the medical qualifications for assistance.
C. Applicant’s long term care insurance policy will be reviewed to determine if it meets the qualifications stated above, and to determine the extent of benefits paid so far by the terms of the policy.
D. In addition to exempting assets routinely exempted under MaineCare rules, the amount of benefits paid to or on behalf of the insured applicant will be disregarded in the eligibility determination.
III. Post-Eligibility Considerations
A. MaineCare benefits will only be paid for those expenses otherwise covered as outlined in the MaineCare Benefits Manual and for which the recipient’s insurance policy has exhausted the benefits.
B. The amount of the individual’s assets disregarded under the above provisions continues to be disregarded post-eligibility throughout the lifetime of the individual, even if the disregarded assets have been transferred post-eligibility.
C. If the policy benefits paid exceed the individual’s assets at the time of application, additional assets up to the value of the benefits paid will be disregarded.
Section 4.2 Assets of Couples Residing in a Nursing Facility
If the total assets of a couple in the same room in a nursing facility exceed the standard for a couple, they can decide who will be the eligible spouse and assets can be transferred to the ineligible spouse. Each spouse is treated as an individual. Coverage can begin for the eligible spouse effective the month countable assets for the eligible spouse are below the standard for an individual.
If the couple reside in different rooms in the same facility or in different facilities, then each is treated as an individual when determining the asset limit. Coverage can begin for the eligible spouse effective the month countable assets for the eligible spouse are below the standard for an individual.
No spousal allowance of income or assets is determined since the ineligible spouse is not living in the community.
Section 4.3: Assets of the Institutionalized Individual with a community spouse
When an institutionalized individual has a community spouse, the couple’s assets are looked at under special rules. These special rules determine how much of the couples assets are attributed to the community spouse and the institutionalized spouse. The amount attributed to
the community spouse is called the Community Spouse Asset Allowance. The amount attributed to the institutionalized spouse is an available asset for the individual.
Determine the Community Spouse Asset Allowance
I. Total all countable assets owned by the community spouse and the institutionalized spouse (his, hers, theirs) on the first day of the month of application.
II. The community spouse is allowed to keep all countable assets owned by the couple up to the Spousal Impoverishment amount in Chart 4.4. This is the Community Spouse Asset Allowance. Any share of the couple's assets over this amount is considered to be available to the institutionalized spouse.
The Community Spouse Asset Allowance may be increased over the Spousal Impoverishment amount of Chart 4.4 if the gross monthly income of the community spouse and the Community Spouse Monthly Income Allocation is less than the Monthly Income Allowance (See Section 6.1.1 in this Part for definitions). This determination is made through the Administrative hearings process described in Section 4.4 of this Part.
III. The $8000 savings exclusion (See Part 16, Section 4.47) is applied to the amount available to the institutionalized spouse. This exclusion is not applied to the total countable assets or to the Community Spouse Asset Allowance.
IV. The result is compared to the asset limit for an individual.
The assets required to meet the Monthly Income Allowance shall be based on the Monthly Income Allowance set at the time of application.
Section 4.4: Hearing to Increase the Community Spouse Asset Allowance
Either the community spouse or institutionalized spouse may request a hearing if they have filed an application and they are dissatisfied with the determination of:
I. The Community Spouse Asset Allowance.
II. The amount of assets attributed to the institutionalized individual.
The hearing will be held within thirty days of the request.
The Department will make a determination of whether an amount greater than the Community Spouse Asset Allowance (Chart 4.4) is needed to raise the community spouse income to the Monthly Income Allowance.
If the individual agrees with the Department’s decision, a hearing is requested using the Consent Decree in Appendix F.
If the individual disagrees with the Department’s determination, s/he may request a face-to-face hearing.
A determination is made as follows on whether assets in addition to the Community Spouse Asset Allowance (Chart 4.4) are needed to meet the Monthly Income Allowance:
I. Monthly Income Allowance and the Community Spouse Income Allocation are determined according to Section 6.1.1 of this Part.
II. the community spouse’s gross monthly income and the Community Spouse Monthly Income Allocation (from the institutionalized spouse) are subtracted from the Monthly Income Allowance. This is the income deficit.
III. the Department will get two estimates of the price of a single premium lifetime annuity that will generate a payment equal to the deficit.
IV. the average of these two estimates shall be substituted for the amount of assets attributed to or protected for the community spouse when the Community Spouse Asset Allowance (Chart 4.4) is less than the averaged cost of an annuity.
If the Community Spouse Asset Allowance in Chart 4.4 is greater than the averaged cost of the annuity, there shall be no substitution for the cost of an annuity.;
V. the spouse is not required to purchase this annuity.
Section 4.5: Transfer of Assets to the Community Spouse
Once the Community Spouse Asset Allowance has been established, the couple has twelve months to transfer the protected assets to the sole ownership of the Community Spouse.
Section 4.6: Non-Cooperation from the Community Spouse
If the community spouse does not make assets available to the institutionalized spouse, eligibility will not be denied if:
I. the institutionalized spouse has assigned to the State any rights to support from the community spouse. A referral will be made to the Third Party Liability Unit (TPL) on behalf of the institutionalized spouse who gains eligibility for nursing care assistance when deemed assets are not made available by the community spouse;
II. the institutionalized spouse is unable to execute an assignment of support due to physical or mental impairment. The State has the right to bring a support proceeding against a community spouse without an assignment under these conditions; or
III. the State determines that denial of eligibility would cause an undue hardship. The consequences of being denied Medicaid for nursing care by itself does not constitute undue hardship.
Individuals must use their income to meet their needs.
Gross non-excluded income is used in determining eligibility. Gross non-excluded income is defined in Part 17 with the following exception: If the income of the institutionalized spouse is being reduced due to previous overpayments by government agencies, the reduced payment amount is used.
Income exclusions used for SSI - Related categories are used to determine gross non-excluded income.
Unless exempt, a transfer of income by the individual is subject to a penalty. Refer to Part 15 to assess if a transfer has occurred and if a penalty needs to be applied.
Section 5.1: Income Ownership
The income ownership rules for purposes of this Part supersede any State laws relating to community property or the division of marital property. The rules of ownership of income are as follows:
I. Income payments made solely in the name of one spouse are available only to that respective spouse.
II. When an income payment is made in the names of both spouses, one half is considered to be available to each, unless there is documentation to the contrary.
III. If the payment of income is made in the names of the institutionalized spouse or the community spouse, or both, and to another person or persons, the income is available to each spouse in proportion to the spouse's interest. When both spouses' names are on the payment and no interest is specified, one half of the couples' interest is considered available to each spouse.
IV. Income from a trust is counted to the extent it is considered available (Part 16, Section 4.53).
Section 5.2: Income Limits
Gross non-excluded income of the individual must be less than the private rate for a semi-private room in the facility where the individual resides.
Section 5.2.1: Income below the Categorically Needy Income Limit
If an individual has income below the categorically needy income limit (see Chart 4.1). See Section 6 of this Part to determine the cost of care.
Section 5.2.2: Income equal to or over the Categorically Needy Income Limit
If an individual has income equal to or over the categorically needy income limit, but under the private rate for the facility a deductible must be met.
Depending on the gross income the deductible is always met by incurring the Medicaid rate or private rate for the facility. Specifics on which rate to use are explained below. Eligibility occurs on the first day of the month of eligibility for the six month period.
The deductible is met as follows:
A. Combine all gross unearned income.
B. Subtract the $20.00 Federal Disregard, where applicable. The remainder is the net unearned income.
C. Combine all gross earned income.
D. Subtract any remainder of the $20.00 Federal Disregard not deducted for the unearned income.
E. Subtract the earned income disregard of $65.00.
F. Divide the remaining earned income by two. The remainder is the net earned income.
G. Combine the net earned and unearned income.
H. Subtract the Protected Income Level (PIL) for one (See Chart 5).
I. Multiply this figure by six to determine the total for the deductible period. This is the individual's deductible.
J. Subtract the cost of:
1. Medicare payments of the individual.
2. Health insurance premiums incurred by the individual for the individual and/or the individual’s spouse if the spouse is covered by Medicaid and is residing in an AFH, FRBH, CRBH, RCF, or AFCH, (as defined in Part 12, Section1), or receiving Home and Community Based Waiver services (See Part 13).
Premiums must be incurred by the Medicaid recipient. If the health insurance is provided by the community spouse through his/her coverage, this is not considered to be a cost incurred by the Medicaid recipient. It is a cost incurred by the community spouse.
Note: Indemnity insurance premiums are not deducted. They are policies that pay for lengths of stay or for a condition and not for specific services. Third Party Liability should be contacted to assess cost effectiveness. If cost effective TPL will arrange for premium payment.
3. Outstanding medical bills incurred by the individual for necessary medical services (See Part 10).
K. The balance is the remaining deductible. The deductible is met as follows:
1. If the gross income is in excess of the Categorical Income limit (Chart 4.1) and less than the Medicaid rate, subtract the Medicaid Rate for the six month period.
2. If the gross income is equal to or over the Medicaid rate for the facility but less than the private rate, subtract the private rate for the six month period.
Institutionalized individuals are responsible for paying toward their cost of care for stays of a full calendar month. This includes those who may have paid privately for a portion of the month.
If an individual moves from one nursing facility to another the payment goes to the facility where the individual was residing on the first day of the month. If the individual moves from one facility to another on the first day of the month, the facility to which the individual moves is paid the cost of care.
If the individual was institutionalized on the first day of the month for which eligibility is being requested, the cost of care begins with that month.
If an individual was living in the community on the first day of the month for which eligibility is being requested then the first cost of care is owed for the following month.
If the individual was in acute status in a hospital for a full calendar month the individual may not owe anything for hospital costs due to payments from Medicare and/or other insurance. A cost of care is still determined. The hospital will be responsible to collect any portion that is actually owed.
When, after third party payments, the balance owed is less than the individual's cost of care, the lesser amount will be collected by the facility. This also applies when an individual is in a skilled nursing facility and covered by Medicare and QMB. A cost of care will be established. Since QMB covers the Medicare co-insurances and deductibles no cost of care will be collected until the Medicare days end.
There is no cost of care for SSI recipients in a medical institution if the Social Security Administration determines that the individual will be returning home within three months of entering the facility.
Individuals who receive SSI and whose total income is less than $60.00 (based on being in a nursing facility) have no cost of care.
The amount of an individual’s cost of care may be adjusted without advance notice (See Section 6.2 of this Part).
Individuals who are no longer in a nursing facility are to be refunded their cost of care for that month by the facility. If the individual is entering a AFH, FRBH, CRBH, RCF, or AFCH (as defined in Part 12, Section1), or receiving Home and Community Based Waiver services (see Part 13). a cost of care may be owed to the new provider based on the eligibility requirements for this new program.
Section 6.1 Determining the Individual’s Cost of Care
The individual’s cost of care is what the individual is expected to pay towards the cost of their care at the institution. The cost of care is determined by considering the individual’s income minus certain expenses and the Community Spouse Monthly Income Allocation.
For individuals who are categorically eligible, there is one determination process to follow. For those who are medically needy the determination process varies, depending on the individual's income.
For any month that an individual is considered to be institutionalized, a community spouse's income is never used in determining the cost of care, including a partial month, except in determining the Community Spouse Monthly Income Allocation.
Section 6.1.1: Determining the Community Spouse Monthly Income Allocation
At the time of application a determination is made of the Community Spouse Monthly Income Allocation.
The Community Spouse Monthly Income Allocation is the amount of income the institutionalized spouse is allowed to give to the community spouse before paying the cost of care.
Definitions
Minimum Monthly Income Standard – This is an amount set by Federal law used in the formula to determine the Monthly Income Allowance (See Chart 4.4).
Monthly Income Allowance – This is the Minimum Income Standard plus excess shelter costs.
Monthly Excess Shelter Standard – This is an amount set by Federal law. If the community spouse has shelter costs that exceed this amount, the excess can be used in determining the Community Spouse Monthly Income Allowance (See Chart 4.4).
Maximum Monthly Income Allocation – This is an amount set by Federal law that establishes the limit on income that can be allocated to the community spouse.
Community Spouse Monthly Income Allocation – This is the Monthly Income Allowance minus the community spouse’s income.
The Community Spouse Monthly Income Allocation is determined as follows:
I. Determine if the community spouse has excess shelter costs:
Total the following shelter expenses for the community spouse’s primary residence:
A. rent or mortgage payment (principal and interest);
B. taxes, homeowner's and renter's insurance payments;
C. maintenance charges for condominiums or cooperatives; and
D. the Standard Utility Allowance used by the State in the Food Supplement Program. The utility standard will be reduced to the extent it is included in cooperative or condominium maintenance fees (See Appendix J for the computation of the utility standard).
1. If the countable monthly shelter expenses are less than or equal to the Monthly Excess Shelter Standard (Chart 4.4), no shelter costs are given in the allowance.
2. If the countable monthly shelter expenses are greater than the Monthly Excess Shelter Standard, the difference is the Excess Shelter Cost.
II. Combine the excess shelter cost with the Minimum Monthly Income Standard. This figure may not exceed the Maximum Monthly Income Allocation. This is the Monthly Income Allowance.
III. Determine the gross monthly income of the community spouse including TANF/SSI payments. Include income actually generated from the Community Spouse Asset Allocation.
IV. Subtract gross monthly income from the Monthly Income Allowance amount in II. above. (If the gross monthly income of the community spouse is equal to or greater than the Monthly Income Allowance, no income allocation is made from the institutionalized spouse).
V. The balance is the Community Spouse Monthly Income Allocation. This income is allocated from the institutionalized spouse to the community spouse.
The Monthly Income Allowance must not exceed the Maximum Monthly Income Allocation (See Chart 4.4).
This allocation can only be increased by:
I. a court order specifying a higher amount, or
II. an administrative hearing that establishes that the community spouse needs income above the Minimum Monthly Income Allowance due to exceptional financial circumstances.
Examples
1. Excess Shelter $ 547
Minimum Monthly Income Standard (Chart 4.4) + $1967
Monthly Income Allowance $2514
Community Spouse Gross Income - $ 500
Community Spouse Monthly Income Allocation $2014
2. Excess shelter $ 1098
Minimum Monthly Income Standard (Chart 4.4) + $ 1967
Monthly Income Allowance $ 3065
The Monthly Income Allowance exceeds the cap set by the Maximum Monthly Income Allocation. This limits the Allowance to the Maximum Monthly Income Allocation.
Monthly Income Allowance Allowed (Chart 4.4) $ 2931
Minus Community Spouse gross income - $ 700
Community Spouse Monthly Income Allocation $ 2231
Section 6.1.2: Administrative Hearing Process for Income
The community spouse or institutionalized spouse may request an administrative hearing if they have filed an application and they are dissatisfied with the determination of:
I. the Monthly Income Allowance;
II. the Community Spouse Monthly Income Allocation; and/or
III. the excess shelter cost.
Either spouse may request a revision of the Monthly Income Allowance if they can establish a need, due to exceptional circumstances, which would create a financial hardship if more funds were not made available. This may occur either through the
hearing process or a court order. The circumstances that caused the request are subject to departmental review yearly to determine if continued receipt of the increased allowance is warranted.
If either spouse establishes that the community spouse needs income above the level otherwise provided by the Monthly Income Allowance, due to exceptional circumstances resulting in significant financial duress, there shall be supplemented to the Monthly Income Allowance, an amount adequate to provide such additional income as is necessary. “Financial duress” is defined as the inability of the community spouse to meet current monthly household and/or medical expenses. “Such additional income as is necessary” is defined as the amount by which the community spouse’s actual and necessary household and/or medical expenses exceed the Monthly Income Allowance.
In order to establish exceptional circumstances resulting in significant financial duress, either spouse must establish that the community spouse has made use of resources and income to meet current monthly household and medical expenses, and
that he or she has no other ability to meet those expenses. Exceptional circumstances will not be deemed to exist where application of the Monthly Income Allowance results in a change or inconvenience to the lifestyle of the community spouse if necessary monthly household and medical expenses can nevertheless be met.
Once an application has been filed, either spouse may request an administrative hearing to increase the Community Spouse Asset Allowance (see Section 4.2 of this Part) if the community spouse's monthly income does not meet the Monthly Income Allowance. The additional assets are requested so that they will generate income and raise the community spouse's total available income to meet the Monthly Income Allowance. The additional allocation of assets to the community spouse may be revised as of the month of application. The Community Spouse Asset Allowance may not be revised prior to that month.
Section 6.1.3: Dependent Allocation
When an institutionalized individual has dependents living at home, an allocation may be allowed for their needs. The method of determining the allocation amount depends on whether there is a community spouse.
For purposes of this section, a dependent is defined as a minor or dependent child, dependent parent(s), or dependent sibling(s) of the institutionalized individual or community spouse, who are residing with the community spouse. These dependents are individuals who may be claimed by the institutionalized or community spouse for tax purposes under Internal Revenue Code.
I. Dependent Allocation with a Community Spouse
To determine the allocation:
A. Determine the gross monthly income of each dependent member including SSI, TANF, and adoption assistance payments. Assets are considered only to the extent of interest or dividend income being generated.
B. Compare the gross income of each individual to the Minimum Monthly Income Standard. (See Chart 4.4)
If the gross monthly income is equal to or greater than the Standard, no allocation is made.
If the gross monthly income is less than the Minimum Monthly Income Standard, subtract the income from the Standard. Divide the remainder by three. The resulting figure is the allocation for each dependent.
II. Dependent Allocation Without a Community Spouse
To determine the allocation:
A. determine the gross monthly income of all dependents living together including SSI, TANF and Adoption Assistance payments. Assets are considered only to the extent of income being generated by the assets.
B. compare the gross income of all dependents living together to the Full Need Standard in Chart 2 for the appropriate unit size. For example, three dependents would use the unit size of three.
If gross monthly income is equal to or greater than the standard, no allocation is made.
If gross monthly income is less than the standard, subtract the income from the standard. The resulting figure is the allocation to the dependents.
Section 6.1.4: Calculating Cost of Care for Individuals below the Categorical Income Limit
I. Determine the individual's gross monthly income
A. If the individual has elected an option under his or her retirement plan that results in a reduced benefit to the individual in exchange for a continued benefit to the spouse upon the individual’s death (e.g. a joint and survivor annuity option), then that reduced amount will be considered to be gross income. However, the reduced amount may be used only if the election is irreversible and the reduction amount does not exceed $1,000 per month.
B. If income is garnished due to a court order for child support the reduced amount of the income is used. The maximum reduction is $1000/child/month.
II. An adjustment may be made if there are current federal, state or local income tax deductions from the individual’s gross income. Usually the amount of taxes withheld will be based on the previous year's income tax return. The adjustment for taxes cannot exceed the current tax liability. A deduction for past due taxes is not allowed.
Examples
1. Last year $600 was the tax liability. $80.00 per month is withheld for income tax. Only $50.00 per month can be
allowed as a deduction as this is the current tax liability ($600 ÷ 12 = $50.00).
2. Last year $600 was the tax liability. $25.00 per month is being withheld for income tax. A deduction of $50.00 per month is allowed as a deduction as this is the current tax liability ($600 ÷ 12 = $50.00).
Note: If an institutionalized individual is paying estimated quarterly taxes, use these for an adjustment in the gross income. The procedure is the same as if the taxes were being withheld.
III. Subtract the appropriate home. This is:
A. $40.00 per month, or
B. $130.00 for the following individuals:
1. those receiving the reduced VA pension of $90.00 who are not in a VA facility, or
2. those in VA nursing facilities who receive a VA pension and are single with no dependents or are the surviving spouse with no dependents
C. up to the maximum dependent allowance (Chart 4.2) for an individual who participates in a sheltered workshop. To determine the actual amount:
1. Subtract $40.00 from any unearned income.
2. Subtract any remainder of the $40.00 from earned income.
3. Subtract $50.00 from any remaining earnings.
4. Subtract one-half of any remaining earnings.
The deductions of $40.00 and $50.00 and the one-half remainder figure are added together. This figure is the personal needs allowance. This figure may not exceed the maximum dependent allowance (Chart 4.2).
IV. Subtract the cost of:
A. Medicare payments for the individual.
B. Health insurance premiums incurred by the individual for the individual and/or the individual’s spouse if the spouse is covered by Medicaid and is residing in a RCF, CRBH, Nursing Facility, or covered by a Home and Community Based Waiver.
Premiums must be incurred by the Medicaid recipient. If the health insurance is provided by the community spouse through his/her
coverage, this is not considered to be a cost incurred by the Medicaid recipient. It is a cost incurred by the community spouse.
Note: Indemnity insurance premiums are not deducted. They are policies that pay for lengths of stay or for a condition and not for specific services. Third Party Liability (TPL) should be contacted to assess cost effectiveness. If cost effective TPL will arrange for premium payment.
C. Certain Medical expenses:
1. Paid or unpaid medical expenses incurred by a Medicaid covered individual, while residing in the facility, for necessary medical services as long as:
a. the service is not covered in the per diem rate of the facility as determined by the MaineCare Benefits Manual.
b. the service is not one the facility is expected to provide. The facility is expected to provide services contained in a written order or plan of care established by the individual’s physician.
2. A medical expense will not be deducted from the cost of care if:
a. the expense was covered by insurance (including Medicare).
b. the expense was not covered due to a Medicaid penalty period of ineligibility.
c. the Department has determined that the expense was not the responsibility of the individual because a medical assessment was not timely requested by the facility or because the facility did not timely and adequately assist the individual with filing a Medicaid application. This determination is made by the Office of Elder Services (OES).
d. the expense is the unpaid cost of care to a medical institution or a waiver agency during periods of Medicaid coverage.
e. the expense was for a Medicaid covered service and the individual was covered by Medicaid.
V. Subtract any spouse's and/or dependent's allocation. These figures are determined in Section 6.1.1 or 6.1.3 of this Part.
VI. The remainder is the individual's cost of care.
Note: If there is a partial month transfer of asset penalty the individual may be responsible for an amount in addition to their cost of care (See Part 15, Section 1.8).
Example
John enters the hospital on 2/17 from home. He moves to a nursing facility on 2/27. He is married and his wife Joan continues to live in their apartment. They have a $13,500 certificate of deposit from which they receive the interest monthly. They also have a checking account with a balance of $738.29. John receives Social Security benefits of $729.50 and Joan receives $529.80. The subsidized rent is $550.00 monthly, including heat and lights.
Income Allocation
Joan's income John's income
$ 529.80 Social Security $729.50 Social Security
+ 65.26 interest income
$ 595.06
$ 600.00 Rent
+ 24.00 Telephone
$ 624.00
- 590.00 (30% of $1967 – Chart 4.4)
$ 34.00 Excess shelter
+1967.00 Minimum Monthly Income Standard (Chart 4.4)
$2001.00 (<$2931 maximum – Chart 4.4)
- 595.06 Joan's income
$1405.94 Income allocation to community spouse
Cost of Care
$ 729.50 John's income
- 40.00 personal needs
$ 689.50
- 104.90 Medicare premium (Appendix C)
$ 584.60
-1405.94 Income allocation to community spouse
0.00 Cost of care
Section 6.1.5: Calculating the Cost of Care for Individuals with Income Equal to or Over the Categorical Income Limit and less than the Private Rate
An individual is not expected to pay more than the Medicaid rate of the facility for a cost of care.
If the individual's gross income is over the Categorical Income limit but under the Private rate of the facility, multiply the daily Medicaid rate of the facility by thirty-one days. Compare the cost of care as calculated in Section 6.1.4 of this Part to the thirty-one day Medicaid rate. The individual is responsible to pay the lesser of the two amounts, either the cost of care or the Medicaid rate.
Example
Dick Reel entered a nursing facility on 1/17/08, from home. Dick receives $2972 in Civil Services benefits, $798 in Social Security benefits and a pension of $1800 monthly. The private rate is $200 per day and the Medicaid rate is $100 per day.
Income
$2972.00 Civil Service
$ 798.00 Social Security
$1800.00 Pension
$ 5570.00 Total
Deductible (See Section 5.2 of this Part)
$ 5570.00 Dick's gross income
- 20.00 Federal disregard
$ 5550.00
- 315.00 PIL (1)
$ 5235.00
X 6 Deductible period
$31410.00 Deductible
- 629.40 Medicare premiums
$30780.60
18600.00 Medicaid rate for 6 months
$12180.60
Because there is a remaining deductible use the Private rate instead of the Medicaid rate for 6 months.
$30,780.60
- $37,200.00 Private rate for 6 months
0.00 Remaining deductible
Cost of Care
$ 5570.00 Dick's gross income
- 40.00 Personal needs
$ 5530.00
- 104.90 Medicare premium
$ 5425.10 Cost of Care
Dick’s cost of care will be $3100 monthly. This is the Medicaid rate for the facility and it is less than the cost of care calculated using the rules in section 6.1.4.
Section 6.2: Changes in the Cost of Care
I. The individual paid a cost of care that was more than what was actually due. When this was due to Department error, the individual cost of care is adjusted retroactively up to one year from the date the error is discovered by the Department. When this was due to error by the individual, no adjustment is made.
II. The individual paid a cost of care that was less than what was actually due. Whether this is due to error by the Department or the individual, the individual’s cost of care is adjusted retroactively up to three months from the date the error is discovered by the Department without advance notice. This includes an adjustment for a lump sum payment (see Section 6.4 of this Part).
Section 6.3 Non-Covered Medical Expenses
Verified medical expenses that can be deducted from the cost of care are deducted for the month following the month the bills are received in the office.
For individuals who die and had incurred non-covered medical expenses, the last cost of care can be adjusted for the month in which they die.
Individuals who only receive $40.00 per month SSI and have a $0 cost of care are not reimbursed for non-covered medical expenses.
Example
Jack Snow purchases two bottles of Tylenol at $11.49 each and two hearing aid batteries at $10.00 each. Receipts are submitted on 3/5. Gross Social Security is $891.80.
Cost of Care
$ 891.50 Gross Social Security
- 40.00 Personal needs
- 104.90 Medicare premium
- 20.00 Uncovered medical expenses (see note below)
$ 726.60 Cost of care
Note: Cannot allow Tylenol - (generic brand for Tylenol is supplied by the facility. If Tylenol is prescribed by a physician and included in the plan of care, it is supplied by the facility and the cost is not allowed as an uncovered medical expense).
Section 6.4: Lump Sums
All lump sum payments, with the exception of SSI, are treated as income in the month received.
Any portion of a lump sum remaining the following month is an asset. Social Security and SSI retroactive payments are an excluded asset for nine months.
Section 6.5: Medicare Buy-In for Institutionalized Individuals
Medicare Buy-In is determined the same as for those who live in the community. See Part 8 for a description of the Buy-In programs.
If a couple is residing in the same room they are considered to be living together. If they are residing in separate rooms they are considered to be living apart.
Aid and Attendance is not used in this process.
When an individual disposes of assets for less than fair market value on or after the look back period they may have to serve a penalty period before coverage can begin for institutional level of care services. The services are:
* Nursing facility services
* Nursing facility services in a medical institution
* Home and Community Based Waiver Services
The individual may be eligible for all other Medicaid services.
Section 1.1: Definition of the look back period
The look back period for all transfers is sixty months prior to the month in which the individual is institutionalized and applies for Medicaid.
If the individual has had multiple periods of institutionalization and/or applications, the look back period starts with the first date on which the individual was institutionalized and applied for Medicaid.
Section 1.2: Definition of “Individual”
In establishing whether a transfer of assets has taken place, the term “individual” includes the individual him/herself as well as:
I. the individual’s spouse; or
II. a person, including a court or administrative body, acting at the direction or upon the request of the individual or the individual’s spouse or with legal authority to act in place of or on behalf of the individual or the individual’s spouse.
Section 1.3: Definition of Assets Subject to Transfer
For transfer purposes, an asset includes all income and resources of the individual and the individual's spouse. This includes any income or resources which the individual or the individual's spouse is entitled to but does not receive because of action or lack of action by the individual as defined above, including but not limited to renouncing an inheritance or failing to exercise a spousal share in a challenge to a will.
To determine the effect that the transfer has on eligibility, several questions must be answered:
I. What was transferred?
II. Who was the transfer made to?
III. When was the transfer made?
IV. What did the individual or couple receive in exchange?
V. Why was the transfer made?
Section 1.4: Exempt Transfers
The following may be transferred without penalty:
I. The home, if it is transferred to:
A. a child who is under age 21 or who does or would meet SSI criteria of total and permanent disability or blindness;
B. a sibling who has an equity interest in the home and was residing in the home for at least one year prior to the individual going to the medical institution.
Example
A brother and sister have joint ownership of a home in which they both lived for the last five years prior to the brother going into a nursing facility. The brother may transfer his interest in the home to his sister without penalty.
A penalty would be established if:
1. the sister was not a joint owner or had no equity interest in the home, or
2. the sister had not lived in the home one year prior to the institutionalization of her brother.
C. a child over age 21 who does not meet the SSI criteria of blindness or disability if the child was residing in the home for at least two years prior to the individual's entering the medical institution and was providing care which enabled the institutionalized individual to live at home rather than a medical institution for this time; or
D. a spouse.
II. Any asset transferred to the individual's child who does or would meet SSI criteria of total and permanent disability or blindness. This exemption also applies to the transfer of assets by the individual or the individual's spouse to a trust established solely for the benefit of the individual's child who does or would meet the SSI criteria total and permanent disability or blindness.
III. Assets transferred to a trust established solely for the benefit of an individual under 65 years of age who does or would meet the SSI criteria of total and permanent disability.
IV. Assets which the owner intended to dispose of at fair market value or for other valuable consideration but, without being at fault, the owner did not obtain full fair market value.
V. Assets transferred exclusively for a purpose other than to qualify for Medicaid either at the time of the transfer or at some future date. "Exclusively" means, transferred for that reason only and solely. It is not enough to prove that there was a reason to
transfer in addition to gaining Medicaid eligibility. The reason for transferring must be exclusive of gaining Medicaid eligibility.
VI. Assets transferred for less than fair market value once all the assets have been returned to the individual. There is no penalty as of the month in which all the assets are returned to the individual. When only part of an asset or its equivalent value is returned, a penalty period can be modified but not eliminated. A penalty remains in effect for the past time period during which the asset had been transferred.
VII. Assets transferred to (or for the sole benefit of) the spouse.
VIII. Assets transferred (sixty months) prior to the month in which the individual is institutionalized and applies for Medicaid. When a transfer involved assets of a trust of any type, the look back period is sixty (See Part 16, Section 4.53).
IX. Assets transferred for Fair Market value.
X. Irregular or infrequent gifts provided the cumulative amount of the gifts do not exceed $500 per calendar quarter. Each gift is analyzed separately. This provision does not mean that the first $500 per quarter is excluded when the cumulative amount of those gifts is more than $500.
A transfer is considered to be for the "sole benefit of" a spouse, blind or disabled child or disabled individual when no individual or entity except the spouse, blind or disabled child or disabled individual can benefit from the assets transferred in any way, whether at the time of the transfer or at any other time in the future.
Section 1.5: Fair Market Value
A transfer for fair market value incurs no penalty. Fair market value may be received in cash by the individual.
Fair Market Value is an amount that can be expected to be received for selling a similar article on the open market in the geographic area involved.
The compensation received for the asset must be in a tangible form with intrinsic value that is equivalent to or greater than the value of the transferred asset. A transfer for love and consideration is not a transfer for fair market value.
Fair market value may be received by the individual in the form of payment of the individual's past medical expenses and debts if measurable and verified. Fair market value must be received by the individual and not delivered at a future date.
Fair market value may also be received in the form of past support for basic necessities if such support is measurable and verified. A reasonable value must be placed on the support provided and the specific time period must be substantiated for which it was given.
Past support for basic necessities does not include any items given as a gift or any services provided by relatives. Past support for basic necessities may include clothing, transportation or personal care provided by a relative only if this clothing, transportation or personal services were provided as part of a legally written enforceable agreement whereby the individual would transfer the asset in payment for clothes, transportation or personal services once those services have been received.
An Individual may only transfer assets for services provided by a relative if the transfer takes place at the time the service is rendered and:
I. the services must be performed after a written agreement has been executed between the applicant and provider. Other provisions stated above continue to apply.
II. at the time of the receipt of the services, the applicant may not be residing in a nursing facility or a CRBH, AFCH, or RCF.
III. at the time of the receipt of the services, the services must have been recommended in writing and signed by the applicant's physician, as necessary to prevent the transfer of the applicant to residential care or nursing facility care. Such services may not include the mere providing of companionship.
IV. at the time of application, the Department will verify the agreement by reviewing the written contract between the applicant and the provider / relative which must show the type, frequency and duration of the services being provided to the applicant and the amount of consideration (money or property) being received by the provider / relative. If the amount paid for the services is above the fair market value of the services at the time the services were delivered, then the applicant will be considered to have transferred the assets for less than fair market value. If in question, fair market value of the services may be determined by consultation with an area business which provides such services.
Section 1.6: Disproving the Presumed Transfer
Any transfer taking place will be presumed to have been made for the purpose of becoming or remaining eligible for Medicaid, unless the individual furnishes clear and convincing evidence that the transaction was for some other purpose and that there was no intent at the time to apply for Medicaid within the foreseeable future. It is the Department's responsibility to demonstrate that a transfer took place and to establish the date of the transfer. It is the individual's responsibility to prove that the transfer took place for reasons other than to gain eligibility for Medicaid.
If the individual wants to disprove the presumption that the transfer was made to establish Medicaid eligibility, the burden of proof rests with the individual. The individual must demonstrate that the transfer was specifically and solely for some other purpose than to receive Medicaid. Statements and evidence to disprove the transfer must be contained in the individual's record.
The statement should cover, but not necessarily be limited to the individual's:
I. purpose for transferring the asset;
II. attempts to dispose of the asset for fair market value;
III. reasons for accepting less than the fair market value for the asset;
IV. plans for and ability to provide financial support after the transfer;
V. relationship, if any, to the persons to whom the asset was transferred; and
VI. belief that the fair market value was received.
In addition to the individual having to prove that the transfer was made specifically and solely for a purpose other than to be Medicaid eligible, other factors to be considered include:
I. a sudden onset of a disability or blindness after the asset was transferred;
II. the diagnosis of a previously undetected disabling condition after the transfer occurred;
III. unexpected loss of other assets following the transfer;
IV. unexpected loss of income after the transfer occurs; and
V. court ordered transfers.
Section 1.7: Establishing Date and Value of a Transfer
This will depend on the type of asset transferred.
I. For assets other than bank accounts a transfer of assets occurs when:
A. title (ownership) or legal interest to property has passed from the individual to another individual. For example: Sole ownership of a home valued at $100,000 is transferred to another. The value of the transfer is $100,000.
B. the individual establishes a joint ownership, tenancy in common, joint tenancy or other similar arrangement, such as adding a name to stocks, bonds, or real property. In addition to legally transferring part ownership, the individual has taken action which reduced or eliminated their ownership or control of the remainder of the asset. The date of the transfer is the date that the joint ownership was established. The amount of the transfer is the total uncompensated value of the asset. For example: In 10/05 the individual establishes joint ownership of their home valued at $100,000. The value of the transfer is $100,000. The date of the transfer is 10/05.
C. the asset is converted from an accessible to an inaccessible asset. An example is when assets are placed in an irrevocable trust.
D. the individual takes action to refuse the receipt of assets.
E. unless otherwise exempt, when real property is sold and the individual holds a promissory note, a transfer of assets must be assessed as follows:
1. if the individual sold property for less than fair market value (see Section 1.5 of this Part), a transfer of assets has occurred amounting to the difference between the sale price (the presumed value of the note) and the value of the property. To determine the sale price the presumed value of the note is used.
2. if the current value of the note is less than the presumed value, the difference between the two amounts is a transfer of assets.
The total amount of assets transferred due to (1) and (2) above incurs a penalty, and the date of the transfer is the date the real property is sold.
F. As of 2/8/06, funds used to purchase a promissory note, loan or mortgage can be considered a transfer of assets unless the note, loan or mortgage:
1. has a repayment term that is actuarially sound (as determined in accordance with actuarial publications of the Social Security Administration, found online at: http://www.ssa.gov/OACT/STATS/table4c6.html).
2. provides for payments to be made in equal amounts during the term of the loan, with no deferral and no balloon payments made; and
3. prohibits the cancellation of the balance upon death of the lender.
If the conditions in 1, 2, and 3 above are not met, the value of the transfer is the outstanding balance due on the note, loan or mortgage as of the date of the individual's application for Medicaid.
G. The individual transfers ownership in real property and retains a life estate. In order to determine the value of the transfer penalty refer to Appendix E – Life Estate and Remainder Interest Table. Using the age of the individual at the time of transfer, find the amount in the column of Chart, "Remainder", and multiply it by the fair market value of the property at the time of the transfer. This is the value of the transfer.
H. The individual transfers a life estate interest in real property. In order to determine the value of the transfer penalty refer to Appendix E – Life Estate and Remainder Interest Table. Using the age of the individual at the time of transfer, find the amount in the column, "Life Estate" and multiply it by the fair market value of the property at the time of the transfer. This is the value of the transfer.
I. Purchase of a life estate after 2/8/06. The money used to purchase a life estate interest in another individual's home is considered a transfer of assets, unless the applicant resides in the other individual's home for at least one full and consecutive year beginning on the date of purchase. The value of the life estate must still be calculated in order to determine if the applicant received fair market value for the purchase, regardless of how long the applicant lived in the home. If the applicant paid more than the life estate is worth, then the difference is a transfer for less than fair market value and is subject to a penalty.
II. With bank accounts, a transfer of funds in an account is determined to take place when:
A. funds, owned by the individual (see Part 16, Section 2.5), are withdrawn by the other joint owner(s) from an account and used for other than the sole benefit of the individual; or
B. another person's name is added to the individual's account, the money in the account is owned by the individual, and the intent of the individual in giving access is to convey ownership of those funds. Intent to convey ownership must be documented with a clearly written statement of intent to transfer the funds in the account to the joint owner. This statement must be:
1. duly executed in the presence of the notary public; and
2. signed by the individual at the time the account was made joint or within a reasonable period of time, usually one week but maybe longer due to circumstances beyond the control of the client.
Note: Evidence of an intent to transfer the funds in the account at the time that the name was added to the account will be rebutted by evidence that the individual continued to use the funds.
Section 1.8: Establishing a Penalty
Once it has been determined that a transfer of assets has occurred for less than fair market value, the penalty period must be determined.
When a penalty is imposed, it is only the long term care services that cannot be paid. The individual may be eligible for all other MaineCare services.
I. The penalty period is determined as follows:
A. Determine the date that each transfer occurred.
B. Determine the amount of the transfer.
C. Divide the amount of the transfer by the average monthly private rate for a semiprivate room for a nursing facility at the time of application (see Chart 4.3). This determines the number of whole months of ineligibility based on the transfer.
D. When the value of the transfer is less than the average monthly private rate for a semi-private room for a nursing facility in Chart 4.3, or the penalty calculation includes a partial month, the partial month shall be counted and implemented as a period of ineligibility using the following method:
1. After determining the amount of transfer and dividing that amount by the average monthly private rate for a semiprivate room for a nursing facility, impose a period of ineligibility for the whole months.
2. Convert the remaining partial month into a dollar amount by multiplying the number of whole months by the monthly private rate used in the calculation above, and subtracting that figure from the total amount of the transfer.
3. This remainder is added to the cost of care for the first month of eligibility after imposing the penalty period.
Example
If the monthly private rate is $6,000 and the transfer amount is $56,400, this would result in a transfer penalty of 9.4 months. To determine the remainder amount, you would take $6,000 X 9 months = $54,000. $56,400 minus $54,000 = $2,400. You would add $2,400 to the cost of care for one month. If the penalty period begins March 1st,
it would end November 30th $2,400 would be added to the cost of care for December.
In an instance where the penalty period is less than a full month the partial month penalty will be added to the cost of care in the first month a cost of care is due.
Example
Individual enters nursing facility November 27th. There is a partial month transfer penalty of $3000. The first month a cost of care is due is December. The $3000 partial month transfer penalty will be added to the December cost of care.
II. If there has been more than one transfer in the same month, the penalty period is determined as follows:
A. Determining the total, cumulative, value of all transfers in the same month.
B. Divide the amount by the average monthly private rate for a semiprivate room for a nursing facility at the time of application (see Chart 4.3). This determines the number of whole months of ineligibility.
C. When the value of the transfer is less than the average monthly private rate for a semi-private room for a nursing facility in Chart 4.3, or the penalty calculation includes a partial month, the partial month shall be counted and implemented as a period of ineligibility using the following method:
1. After determining the amount of transfer and dividing that amount by the average monthly private rate for a semiprivate room for a nursing facility, impose a period of ineligibility for the whole months.
2. Convert the remaining partial month into a dollar amount by multiplying the number of whole months by the monthly private rate used in the calculation above, and subtracting that figure from the total amount of the transfer.
3. This remainder is added to the cost of care for the first month of eligibility after imposing the penalty period. In an instance where the penalty period is less than a full month the partial month penalty will be added to the cost of care in the first month a cost of care is due.
III. If there have been multiple transfers occurring in more than one month during the look-back period, all transfers can be added together into one penalty period using the following method:
A. Accumulate all transfers.
B. Divide the amount by the average monthly private rate at the time of application for a semiprivate rate for a nursing facility (See Chart 4.3). This determines the number of whole months of ineligibility.
C. The transfer is treated as one transfer and is treated as if it occurred on the earliest date of the multiple transfers.
D. When the value of the transfer is less than the average monthly private rate for a semi-private room for a nursing facility in Chart 4.3, or the penalty calculation includes a partial month, the partial month shall be counted and implemented as a period of ineligibility using the following method:
1. After determining the amount of transfer and dividing that amount by the average monthly private rate for a semiprivate room for a nursing facility, impose a period of ineligibility for the whole months.
2. Convert the remaining partial month into a dollar amount by multiplying the number of whole months by the monthly private rate used in the calculation above, and subtracting that figure from the total amount of the transfer.
3. This remainder is added to the cost of care for the first month of eligibility after imposing the penalty period. In an instance where the penalty period is less than a full month the partial month penalty will be added to the cost of care in the first month a cost of care is due.
IV. The penalty period for transfers begins with the later of:
A. the first day of a month in which the transfer for less than fair market value occurred; or
B. the first day of the month the individual is eligible for Medicaid and would otherwise be receiving help with the cost of long term care services based on an approved MaineCare application were it not for the Department imposing an asset transfer penalty period; and
C. the first day which does not occur during any other period of ineligibility.
V. At the time both spouses become institutionalized, have applied for and are otherwise eligible for MaineCare and there is a penalty period in effect for either spouse, the remaining penalty period can be divided between the spouses into any combination of full months. Whether there is a division of the penalty and, if so, how it will be divided, is a decision of the spouses.
When, for some reason, one spouse is no longer subject to a penalty (for example, no longer lives in a nursing facility or dies), the remaining period applicable to both spouses must be served by the remaining spouse.
Section 1.9: Hardship Waiver
The individual applying for help with the cost of nursing facility services or home and community based waiver services may be able to get the period of ineligibility waived if they can show that the transfer penalty places them in an undue hardship situation. It is the responsibility of the individual to prove the claim of undue hardship.
I. Determine if undue hardship exists. An undue hardship exists if this denial would:
A. deprive the individual of medical care such that the individual’s health or life would be threatened; or
B. deprive the individual of food, clothing, shelter, or other needs of life.
II. Determine whether to waive the penalty when undue hardship exists. The penalty can be waived if:
A. the individual was exploited as assessed by the Office of Aging and Disability Services; or
B. the individual can prove all of the following:
1. Neither the individual nor the spouse have the means to pay for the cost of nursing facility or home and community based waiver services, taking into consideration all exempt and non-exempt income and assets.
2. The recipient of the transferred asset is unable or unwilling to make the value of the transfer or any part of it available to pay for the individual’s cost of nursing facility or home and community based waiver services.
3. The individual has made all reasonable efforts to recover the transferred asset or its equivalent value. The individual must cooperate with the Department in any recovery activity that is undertaken.
4. The individual must agree in writing that if the transferred assets or equivalent value are recovered, the individual will reimburse Medicaid for funds expended as a result of the approved claim of undue hardship.
III. The result of being denied Medicaid for nursing facility services or home and community based waiver services, by itself, is not considered undue hardship.
IV. The Department will use the following process for undue hardship determinations:
A. All denials/closures due to a transfer of assets will include a written notice that an “undue hardship” provision exists and can be considered according to the criteria indicated above if the applicant/recipient requests it.
B. A claim of undue hardship must be made no later than thirty days from the date of the denial/closure notice. With the individual’s written permission, an authorized representative or the facility in which the individual resides can claim undue hardship on the individual’s behalf.
C. A decision on a claim of undue hardship will be made and the applicant notified in writing within thirty days of the claim being made.
D. An appeal from any adverse action including a denial of a claim of undue hardship must be made within thirty days of the notice of denial. Applicants/recipients will be given written notice of this right to a hearing.
E. In II. B.1. above, the Department will not use income and assets provided to the community spouse to prevent impoverishment in determining whether
the individual or the spouse have the means to pay the cost of long term care services in the facility.
ANNUITIZED ANNUITY: An annuity under which the individual is receiving a benefit payment under a payment option (life only, ten year certain, etc.) which they have selected.
ANNUITY: An annuity is an investment on which an individual receives fixed payments for a lifetime or a specified period of time.
ASSETS: Cash, other liquid resources or real or personal property.
AVAILABLE ASSET: An asset that has a value which is legally obtainable by the individual. If there is a penalty for early or late withdrawal to get the asset, the available asset is the amount after the penalty is taken.
DEFERRED ANNUITY: An annuity under which the benefit payment will begin at some future date. The individual has not yet selected a payment option (life only, ten year period certain, etc.)
EQUITY VALUE: The fair market value of real or personal property minus any encumbrances. Examples of encumbrances are: mortgages, liens, and other debts on or attached to the property.
Any asset which has no saleable value will not be used in determining eligibility because it has no equity value.
Examples
Homes that, due to structural damage, and their location on leased property, have no resale value.
Vacant property not large enough to be sold due to changes in zoning laws.
Vehicles, which cannot be sold due to mechanical or other problems.
FAIR MARKET VALUE: Amount that can be expected to be received for selling a similar article on the open market in the geographic area involved. The individual may refute the fair market value determined by the Department by providing statements from two credible sources.
LIQUID ASSETS: Cash or other resources that can be converted into cash on demand.
NON-LIQUID ASSETS: Real or personal property that cannot be converted into cash on demand.
OWNERSHIP: Power, authority or title to sell, exchange, convert or redeem any property. Property in the name of a child is available to both child and parent, as the parent can make it available.
REAL ESTATE AND OTHER NON-LIQUID ASSETS:
In determining the value of this countable asset, the type of ownership must be established.
If the owners have "joint tenancy", each owner has an equal interest in the total value of the property.
If the owners are "tenants in common", each owner has a share in the property. Generally, each owner can sell that share without the consent of the other owners. If the terms of ownership prohibit sale of one owner's portion or the other owner(s) refuses to agree to sell, the real estate is excluded.
UNAVAILABLE ASSET: An asset that has a value which is legally unobtainable to the individual.
Individuals must use their assets to meet their needs before MaineCare will be available. Specific types and amounts may be retained to meet current and future needs. See explanation of specific assets that follow.
If assets are potentially available, applicants, recipients or others acting on their behalf must take action to make them available.
All available assets are to be used in determining eligibility.
Unavailable assets are not to be used in determining eligibility.
Section 3.1: Eligibility Groups for Which MAGI-based Methodology Applies
All assets are excluded for eligibility groups for which MAGI-based methodology applies.
Section 3.2: All Other Eligibility Groups
Unless specifically indicated as excluded or unavailable, all assets are counted toward the appropriate limit (Part 7) whether listed in Section 4 of this Part or not.
For the purpose of this Part, SSI - Related categories refer to Parts 6, 9. 11, 12, 13, and 14.
Section 4.1: Agent Orange - excluded for SSI-Related categories
All Agent Orange settlements as provided for under PL 100- 687 and 101-201 are excluded.
Section 4.2: Alaskan Native Claims - excluded for SSI-Related categories
The tax-exempt portions of payments made pursuant to PL 92-203, the Alaskan Native Claims Settlement Act are excluded.
Section 4.3: Annuities - partially excluded for SSI-Related categories
A. Policy applicable to all MaineCare including residential care and long term care
An annuity may be purchased by the individual or a third party. If the annuity is purchased by other than the individual, the payments are counted as income. There is no countable resource nor is there a transfer of assets.
(1) Annuities purchased before 2/8/06
(a) The current cash value of the annuity available to the individual, including the principal and interest earned on the principal, minus any penalty fees for withdrawal, is a countable resource.
(b) Payments from annuities are considered income to the individual for whom the payments are designated.
(2) Annuities Purchased on or after 2/8/06
(a) Payments from annuities are considered income to the individual for whom the payments are designated.
(b) The current cash value of the annuity available to the individual including the principal and interest earned on the principal minus any penalty fees for withdrawal is a countable resource.
B. Policy applicable to long term care –
Applicants for and recipients of Medicaid long term care or residential care coverage must disclose a description of any interest the individual or community spouse has in an annuity regardless of whether the annuity is irrevocable or is treated as an asset. This must be disclosed at the time of initial application and at re-determination.
(1) Annuities purchased before 2/8/06
If the individual has purchased other than a straight life annuity, a transfer of assets has occurred. This is because the individual has purchased not only a benefit for him/herself but also payments to a beneficiary. The value of the transfer is equal to the difference between the cost of the annuity purchased and the cost of a straight life annuity providing the same monthly benefit. The date of the transfer is the date the payment option is selected and the funds cannot be returned to the individual. To determine if the transfer is subject to a penalty, refer to Part 15.
(2) Annuities Purchased on or after 2/8/06
(a) An annuity purchased by or on behalf of an annuitant who has applied for Medicaid with respect to long term care services will be treated as a transfer of assets unless:
(i) the annuity is an Individual Retirement Annuity (26 U.S.C. §408(b,q); or
(ii) the annuity is purchased with proceeds from
an Individual Retirement Account or a simple retirement account (26 U.S.C. §408(a), (c), or (p);
a simplified employee pension (26 U.S.C. §408(k); or
a Roth IRA (26 U.S.C. §408); or
(iii) the annuity is:
irrevocable and non-assignable; and
actuarially sound (as determined in the Social Security Administration Life Expectancy Table. This table can be found on the internet at http://www.ssa.gov/OACT/STATS/table4c6.html); and
provides for payments in equal amounts during the term of the annuity, with no deferral and no balloon payments made.
(b) The purchase of an annuity by the individual or the community spouse shall be treated as the disposal of an asset for less than fair market value unless:
(i) the State of Maine is named as the remainder beneficiary in the first position for the total amount of Medicaid paid on behalf of the individual; or
(ii) the State of Maine is named as such a beneficiary in the second position after the community spouse or minor or disabled child and is named in the first position if such spouse or representative of the child disposes of their remainder for less than fair market value.
Section 4.4: Assets being converted – excluded for SSI - Related categories
Assets which are in the process of being converted are exempt during the period they are unavailable.
Examples
insurance policies which have been sent to the insurance company,
property which is being probated and
stocks which have been submitted for redemption.
Section 4.5: Bank accounts (including savings, checking, money market and certificates of deposit) -
Included are individual and jointly owned bank accounts and other jointly owned liquid assets:
A. Individual Accounts - the funds in these accounts are to be totally available to the individual.
B. Joint Accounts:
(1) Funds in these accounts are considered to be owned by the individual unless there is proof that funds in the account were contributed by another joint owner of the account.
If the individual claims that s/he does not own the money in the account s/he must provide evidence that this money belongs to the other joint owner(s). Any money in that account which the individual can show was contributed by one of the other joint bank account owners is excluded.
Verification of ownership of the funds may be shown through bank statements, written statement from the source that provided the funds to the account, letters of award showing proof of ownership, or other clear and convincing evidence satisfying the Eligibility Specialist that the money in the account is not available to the applicant or recipient
Any money in the account which, even though contributed by the joint owner, is intended for use by the applicant/recipient (such as a gift) is countable to the individual. The Department will presume this portion is considered as any other available asset unless credible evidence is given showing this was not a gift.
(2) When evidence is provided that funds in the account belong to another joint owner, the individual must remove her name from the account or establish a separate account with the funds she does own. This must be done within thirty days of successful presentation of ownership evidence.
If it is necessary to obtain guardianship, conservatorship or power of attorney for one of the joint owners, the thirty day count will not begin until the process of obtaining guardianship, etc., is completed. If the Department determines that there is no active pursuit of the appointment, the thirty day count will begin.
The account will be considered owned in equal portions when the two or more joint holders are eligible individuals or couples.
When a joint name is added to the account, funds are considered to be transferred to the joint name added if conditions in Part 15, Section 1.7 (II) are met.
Examples
(a) Mr. and Mrs. Jones have a 33 year old son, John. Because John has to travel a great deal to work he added his parents' names to his savings and checking accounts so they could pay his bills if needed. The Jones' were able to verify that John had deposited from his own money all of the funds in the account and that all of the transactions were for his benefit. They were given thirty days to remove their names from the accounts.
(b) Martha Thompson has a joint checking account with her daughter, Jane. Jane has POA for her mother. Jane's paychecks ($1400 monthly) and Martha's Social Security check ($600) both go into this account. They live together and split expenses. Jane does not need to invoke her POA to access the money in the account. Since only 30% of the money going into the account is from Martha's income, only this percentage of the total balance is considered to be hers. Martha will have thirty days to remove Jane's name or to establish an account of her own, with her portion of the funds.
C. Other jointly owned liquid assets –
A distinction is made between jointly owned bank accounts and other jointly owned liquid assets, such as stocks and bonds.
For other types of jointly owned liquid assets, each joint owner owns an equal share of the asset. For example, if there were 3 joint owners each would own a one-third interest in the asset.
Example
Two sisters are applying for assistance. They have stocks left to them by their brother. This is verified by a copy of his will. Instead of the entire value being counted by each, one half of the value counts for each sister.
If the individual or couple establish that other joint owners refuse to sell jointly owned property, the value of the asset is excluded. This exclusion does not apply if any joint owner has the ability to convert the jointly owned asset to cash without the permission of the other owners or if the joint owners are a couple. See the policy on transfers for a possible transfer penalty the individual has established joint ownership.
Section 4.6: Burial Contracts/Spaces/Funds
A. Excluded for SSI-Related categories:
(1) Prepaid burial contracts (mortuary trusts) set up before March 1, 2006, regardless of value.
(2) Prepaid burial contracts (mortuary trusts) established on or after March 1, 2006 but prior to April 1, 2024 are excluded as long as either the contract is less than or equal to the statewide average for burial and funeral costs of
$12,000. If the contract is for more than $12,000 then the estate of the Medicaid recipient must be named the beneficiary of any funds remaining after payment of funeral and burial charges.
(3) Prepaid burial contracts (mortuary trusts) established on or after April 1, 2024, that are irrevocable, are excluded so long as either the contract is less than or equal to the statewide average for burial and funeral costs of $18,000. If the contract is for more than the excluded amount, then the estate of the Medicaid recipient must be named the beneficiary of any funds remaining after payment of funeral and burial charges. Effective January 1, 2025, the excluded contract amount will increase annually, by the same percentage as the percentage increase of the Consumer Price Index for the preceding year. The Consumer Price Index is updated periodically in the Federal Register by the U.S. Department of Labor under the authority of 49 U.S.C. § 33105(c). To calculate the increased excluded contract amount, the Department shall multiply the current excluded amount by the percentage increase of the Consumer Price Index, for the preceding year, and then add that amount to the current excluded contract amount, with effective dates of January 1, and posted online at https://www.maine.gov/dhhs/ofi/programs-services/health-care-assistance.
(4) Burial spaces intended for the use of the individual, spouse or other member of the immediate family, are an excluded asset.
B. For SSI - Related categories:
(1) Separate identifiable account for their burial expenses.
(a) For each individual exclude up to $1500 set aside in a separate identifiable account for their burial expenses as long as the individual does not have a total of $1500 in all of the following funds:
prepaid burial
excluded face value of whole life insurance
cash value of counted whole life insurance policies
prepaid burial contract
(b) In order to be excluded as "funds designated for burial", funds held as cash, (i.e., bank accounts or certificates of deposit), must be separately identifiable as a different account and cannot be co-mingled with non-burial related funds.
(c) The funds are excluded as burial funds effective the month in which they are separated.
(d) Once this money is considered a designated burial fund certain conditions must be met:
(i) there must be documentation in the case to show that no transactions are made to the asset except for the posting of interest and the addition of funds.
(ii) any interest accrued is excluded as income or asset as long as the individual remains continuously eligible for MaineCare and no withdrawals are made from the fund. Interest on these funds is excluded even if the total amount of the original designated funds plus the accumulated interest exceed the $1500 limit.
Examples
The individual indicates that a savings account of $1450 has been set aside for burial. At the time of the next review, the savings account has increased due to accumulated interest to $1563. The entire savings account continues to be an excluded asset and the interest is not considered income.
Several months later, the individual becomes ineligible for MaineCare. If the individual reapplies and continuous coverage does not exist, up to $1500 of the designated burial funds and accumulated interest since the original designation can be excluded as an asset.
(e) At time of review, if burial funds have been co-mingled with non-burial related funds, the individual must be given an opportunity to separate the funds before they are counted as a resource. The funds must be separated by the end of the month that is two months after the month of review in which the individual is advised of the need to separate the funds.
Example
If the review is due 9/07 the individual should be advised that funds must be separated by 11/30/07. If they are not, the exclusion does not apply unless the reason for non-separation is beyond the control of the individual.
(f) Determine whether the separate identifiable account can total $1500 as follows:
(1) Term insurance is excluded as an asset and does not count against the $1500 limit.
(2) For each individual deduct the amount of any prepaid burial contracts from the $1500 limit.
(3) If the face value of whole life insurance has been excluded, deduct the amount of the face value from the $1500 limit (See Section 2.27 of this Part).
(4) If an individual's whole life policies are not excluded then deduct the cash value from the $1500 limit. If there is a loan against the policy, deduct the net cash value from the $1500 (See Section 2.27 of this Part).
Examples
The individual has one insurance policy with a face value of $1600 and a cash value of $1300. There are no prepaid burials. The policy can be considered a $1300 designated burial fund.
The individual has one insurance policy with a face value of $1600 and a cash value of $1800. There are no prepaid burials. The policy can be considered a $1500 designated burial fund. The remaining $300 cash value is added to the other countable assets.
The individual has one insurance policy with a face value of $1600 and a cash value of $1700. There is a prepaid burial plan for $500 as well. Only $1000 of the cash value can be considered a designated burial fund as the allowable limit of $1500 is offset by the $500 prepaid burial. The remaining cash value of $700 is added to other countable assets.
$ 1700 Cash surrender value of whole life insurance policy
+ $ 500 Add: Prepaid burial contract
$ 2200 Total
- $ 1500 Maximum exclusion
$ 700 Countable asset
Section4.7: Certificates of Deposit - countable for SSI-Related categories
The amount of the countable asset is the proceeds available to the individual or couple if they were to cash in the certificate now, minus penalties for early withdrawal. Taxes are not treated as a penalty.
Section 4.8: Commercial Transportation Tickets - excluded for SSI-Related categories
The value of a domestic commercial transportation ticket received as a gift by an individual (or his or her spouse) and not converted to cash will be excluded in the determination of the individual's assets. Domestic travel is defined as travel among the 50 States, the District of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.
Section 4.9: Continuing Care Retirement Communities (CCRC) / Life Care Community (LCC) partially excluded for SSI - Related categories
Admission contracts offer a range of housing and health care services to serve older persons as they age and as their health care needs change over time. CCRC’s generally offer independent living units, assisted living, and nursing facility care for persons who can afford to pay the entrance fees. These facilities are paid primarily with private funds, but a number also accept Medicaid payment for nursing facility services. In order to operate in the State of Maine, this type of facility must have permission from the Bureau of Insurance and be licensed by the Department of Health and Human Services.
The CCRC and LCC facilities that accept Medicaid payment are allowed to require in their admissions contracts that residents spend their resources, declared for the purposes of admission, on their care before they apply for Medicaid. With this in mind, an applicant for Medicaid who has resided in such a community must provide a copy of their admission contract as part of their Medicaid application. If there is an additional contract related to their entrance fee, that must be provided also. If the contract provides for a lifetime care agreement, the applicant will be ineligible for Medicaid.
The individual's entrance fee in a CCRC or LCC shall be considered an available asset for the purposes of Medicaid eligibility to the extent that:
A. the individual has the ability to use the entrance fee, or the contract provides that the entrance fee may be used, to pay for care should other resources or income of the individual be insufficient to pay for such care.
B. the individual is eligible for a refund of any remaining entrance fee when the individual dies or terminates the contract and leaves the facility; and the entrance fee does not confer an ownership interest in the CCRC or LCC.
For applicants with community spouses, only that part of the entrance fee that is not protected for by the community spouse's resource allowance would be considered a countable asset.
Section 4.10: Disaster Relief Act - excluded for SSI - Related categories
Assistance received under the Disaster Relief Act of 1974 (PL 93-288), or other assistance provided under a federal statute because of a catastrophe which is declared to be a major disaster by the President of the United States, is excluded in determining countable resources:
A. for a period of nine months from the date of receipt;
B. interest earned on the assistance is excluded from resources for a period of nine months beginning on the date the assistance is received; and
C. the initial nine month period will be extended for a reasonable period up to an additional nine months when it is found the individual has good cause for not having necessary repairs or replacement of damaged or destroyed property completed. Good cause exists when circumstances beyond an individual's control prevented the repair or replacement of such property within the nine month time period.
Section 4.11: Disaster Unemployment Assistance – excluded for SSI-Related categories
Disaster Unemployment Assistance authorized in P.L. 100-707, U.S.C. Section 5155(d) (1988) is excluded. This is paid to an individual unemployed as a result of a major disaster.
Section 4.12: Earned Income Tax Credit (EITC) – excluded for SSI-Related categories
Excluded for the month of receipt and the following month.
Section 4.13: Energy Assistance (Other than HEAP) - excluded for SSI-Related categories
Any other benefits paid through federal laws to eligible households for the purpose of providing energy assistance is excluded.
Section 4.14: Escrow Accounts - excluded for SSI-Related categories
Escrow accounts set up by the U.S. Department of Housing and Urban Development (HUD) for families who are participating in the Family Self Sufficiency Program are not considered a countable resource.
Any interest paid on these accounts is not countable income. As long as the individual is receiving any state, federal or other public assistance for housing they cannot access this amount.
This program is a five year program open to all Section 8 housing participants which aims to help the family to become self-sufficient at the end of the five year period.
When the account becomes available, it is counted as a resource and/or interest income.
Section 4.15: Experimental Housing Allowance Payments – included for SSI-Related categories
Payments made under Annual Contributions Contracts entered into prior to 1/1/75, under Section 23 of the US Housing Act of 1937, as amended.
Section 4.16: Food Produced for Home Consumption – exclude for SSI-Related categories
Food produced in home farming for consumption by the assistance unit is excluded.
Section 4.17: Governor Baxter School for the Deaf Compensation - excluded for SSI-Related categories
One time cash payment from the Governor Baxter School for the Deaf Compensation Authority. Interest on this compensation is excluded as income and any accrued interest is excluded as an asset.
Section 4.18: Grants, Loans, and Scholarships
A. Administered by Commissioner of Education – PL 90-575 – Title V –
The grants and loans are:
Basic Education Opportunity Grant Program (Pell Grants)
National Direct Student Loan program (Perkins Loans)
Supplemental Education Opportunity Grant Program (SEOG)
Guaranteed Student Loan Program
State Student Loan Program
SSI - Related categories – exclude for all undergraduates and exclude only tuition and fees for graduate students
B. All other grants/loans/scholarships:
SSI - Related categories – exclude tuition and fees for undergraduates and count for all other students
Section 4.19: Home Energy Assistance Program (HEAP) – excluded for SSI-Related categories
Benefits paid to eligible households under the Home Energy Assistance Act of 1980, Title III of PL 96-223 (LIHEAP) is excluded.
Section 4.20: Household Goods – excluded for SSI-Related categories
Items used in day-to-day living such as clothing, household furnishings, utensils, home and property maintenance tools and equipment, heirlooms, wedding and engagement rings, basic jewelry.
Section 4.21: Housing Act Assistance – excluded for SSI - Related categories
Effective 10/1/76 the value of any assistance paid with respect to a dwelling unit under the United States Housing Act of 1937, the National Housing Act, section 101 of the Housing and Urban Development Act of 1965, or Title V of the Housing Act of 1949 as provided by section 2(h) of PL 94375.
Section 4.22: HUD Community Development Block Grant – included for SSI-Related categories
HUD community development block grant funds received to finance the rehabilitation of privately owned residences. Individuals receiving a grant are precluded by HUD regulations from using grant monies for purposes other than major property repairs or capital improvements. Payment is by check made payable either directly to the contractor or jointly to the contractor and property owner.
Section 4.23: Income Remaining After the Month of Receipt - included for SSI-Related categories
Any portion of income (including, but not limited to: lump sums for wages, inheritances, and lottery winnings) that remains following the month the income was received is counted with all other assets. This provision pertains to all types of income including lump sums from wages, inheritances and lottery winnings.
Section 4.24: Individual Development Accounts (IDA) - excluded for SSI-Related categories
An IDA is a special bank account that is set up by or for the individual to allow the individual to accumulate funds for specific purposes.
There are two types of IDA's in Maine: a Family Development Account (FDA) for TANF recipients and a Demonstration Project IDA which is available to anyone. The Demonstration Project IDA is also known as Assets for Independence Act (AFIA) IDA. Individual contributions to either IDA are matched by state and/or federal funds.
A. Family Development Account (FDA for TANF recipients):
(1) Any income used by the individual to fund this account is excluded as income.
(2) Any asset used by the individual to fund this account is excluded as an asset including up to $10,000 of lump sum income remaining in the month following receipt.
(3) Any individual contributions that are matched are excluded as income or asset.
(4) Accrued interest on FDA funds is excluded as income or asset.
(5) Withdrawals from these accounts at any time must be used for the following purposes in order for the fund to remain an exempt asset. When withdrawals are used for any other purpose this will result in the fund being considered a countable asset effective the month of the withdrawal. The TANF Program determines if this condition is met.
(a) expenses for education or job training to attend an accredited or approved post-secondary education or training institution;
(b) the purchase or repair of a home that is the primary residence;
(c) the purchase or repair of a vehicle used for transportation to work or to attend an education or training program;
(d) capital to start a small business for any member of the assistance unit 18 years of age or older;
(e) health care costs of a member of the assistance unit that are medically necessary and that are not covered by public or private insurance;
(f) to address an emergency that may cause the loss of shelter, employment or other basic necessities; or
(g) to address other essential family needs approved by the Department.
B. Demonstration Project Account (AFIA):
(1) any income used by the individual to fund an AFIA is excluded as income.
(2) any individual contributions that are matched are excluded as income or assets.
(3) accrued interest on AFIA funds is excluded as income or assets.
(4) withdrawal from these accounts is allowable only for certain reasons as determined by the agency authorizing this IDA. These reasons include post- secondary educational expenses, acquiring a residence, or expenditures for operating a business.
Section 4.25: Insurance Settlements – partially excluded for SSI-Related categories
Portions of insurance settlements earmarked and used, or intended to be used for specific purposes, are exempt for 6 months from date of receipt. Examples are back medical bills and attorney and legal fees associated with the settlement.
Verification of use, or intent to use, may be shown through verbal or written statements from those providers to whom the individual owes money associated with the settlement. For example, unpaid medical bills or attorney fees.
Portions of insurance settlements not specifically earmarked and used or intended to be used for specific purposes are income in the month received and any remaining portion is an asset in the following month.
For specific information regarding accident and injury settlements when the individual was on MaineCare see Part 2, Section 6.
For settlements associated with the replacement of an excluded asset, see Section 4.43 of this Part.
Section 4.26: Job Corps – included for SSI-Related categories
All Job Corps payments except on-the-job training income of an individual, at least 19 years old, who is not a dependent child.
Section 4.27: Life Estate - included for SSI-Related categories
A "life estate" is ownership of real property. Ownership is limited to the term of life, usually that of the owner of the life estate, and may have other conditions attached such as occupancy.
Life estates can be acquired by inheritance or by purchase, or can be retained when property is sold, such as when the individual sells the right to ownership after death and retains the right to ownership during their lifetime.
The monetary value of a "life estate" and the "remainder" must be established so that the applicant's assets or transfer of assets can be properly valued.
To establish the value of the property rights, refer to Appendix E.
Using the individuals’ age, find the amount in the first column, “Life Estate”, and multiply it by the current fair market value of the property. The result is the current value of the life estate owned by the individual. This is a countable asset but can be exempted with an intent to return if the real property is the primary residence.
Section 4.28: Life Insurance
Term life insurance is an excluded asset since it has no cash value.
Life insurance is excluded as long as the combined face value of all whole life policies owned by the individual on the same insured does not exceed $1500. If the total face value of all whole life policies owned by the individual on the same insured exceeds $1500, then the cash values, minus any outstanding loans, is counted against the asset limit. A portion of the cash value may be excluded for burial purposes (See Section 2.6 of this Part).
Examples:
A. An individual has a face value life insurance policy of $1000 and one for $500. Even if the cash value exceeds $1500, these are excluded.
B. An individual has a $2000 face value whole life policy. The cash value is $1790. This results in assets of up to $1790 counted against the asset level. Also see Section 4.6 of this Part for potential exclusions for burial purposes.
C. An individual has a $2000 face value whole life policy. The cash value is $1790 but there is a $500 outstanding loan against the policy. This could result in an asset of up to $1290 ($1790 minus the $500 loan) counted against the asset limit (See Section 4.6 of this Part regarding exclusions for burial purposes).
D. An individual owns a policy on himself that has a $1000 face value and owns a policy on his wife with the same face value. Even though both policies are owned by the individual they are exempt because the total face value on each insured is under $1500.
Section 4.29: Life Lease (Tenancy) - excluded for SSI-Related categories
This is a contract arrangement to live in a certain place, usually for the term of life. It is not ownership and therefore is not a countable asset.
Section 4.30: Loans – excluded for SSI-Related categories
Money borrowed by an individual is not counted as either an asset or income for the month received. Any remainder is considered an asset in the following month.
Written statements from both the individual and the party lending the money must be obtained indicating that the funds are a loan, the amount and the plan for repayment. Without verification of the loan the funds will be considered a gift and treated as a lump sum (See Section 4.31 of this Part).
Section 4.31: Lump Sum Payments – partially excluded for SSI-Related categories
Income that has accumulated and is received in one payment by the individual is considered a lump sum. This includes Worker's Compensation, Retroactive Social Security payments, Unemployment Benefits received retroactively due to the result of a hearing, and Veteran's Benefits. Gifts, inheritances, lottery winnings and insurance settlements are also considered to be a lump sum payment.
Lump sum payments are counted as income in the month received, and any remaining the next month are counted as an asset. SSI lump sum payments are excluded income.
SSI or Social Security retroactive payments are excluded as an asset for nine months. After that, any portion remaining becomes a countable asset.
Section 4.32: Native American payments - excluded for SSI-Related categories:
A. Any payments distributed per capita to or held in trust for members of any Indian tribes under PL 92-524, 93-134, 94-540, 97-458 or 98-64.
B. Receipts distributed to members of certain Indian tribes referred to in Section 5 of PL 94-114, effective 10/17/75, and PL 98-123 and 98-124, effective 10/13/83.
C. Any income or assets accruing to members of the Passamaquoddy Tribe, the Penobscot Nation and the Houlton Band of Maliseet Indians pursuant to PL 96-420 (the Maine Indian Claims Settlement Act of 1980).
D. The tax exempt portions of payments made pursuant to PL 93-203, the Alaskan Claims Settlement Act.
E. Native American payments as detailed in Title 20 CFR, Part 416 Appendix to Subpart K (IV)(b) and (c).
F. Per capita distribution payments, receipts from trust lands and dividend payments to members of various native American and Indian tribes such as Blackfeet, Gros Ventre, Grand River Band, Alaskan Native Claims Settlement Act under the provisions of Distribution and Judgment Funds (PL 92-254 Sections 4, 6, and 7), Receipts from Lands Held in Trust for Indian Tribes (PL 94114, Section 6).
G. Any assets accruing to members of the Passamaquoddy Tribe, the Penobscot Nation and the Houlton Band of Maliseet Indians pursuant to PL 96-420, the Maine Indian Claims Settlement Act of 1980.
Section 4.33: Nazi Persecution Payments – excluded for SSI-Related categories
Payments made to victims of Nazi persecution under Public Law 103-286 (Nazi Persecution Victims Eligibility Benefits).
Section 4.34: Nutrition and Food Assistance – excluded for SSI-Related categories
The value of food assistance received under the Child Nutrition Act of 1966, as amended, and the special food service program for children under the National School Lunch Act, as amended (PL 92-433 and PL 93-150). Any benefits received under Title VII, Nutrition Program for the Elderly, of the Older Americans Act of 1965, as amended.
The value of benefits received under the Food Supplement Program (formerly Food Stamps) or Donated Commodities is excluded.
Section 4.35: Pension Plans (Individual and Employee)
Funds are a countable asset at the point they are made available.
For example, a retirement fund owned by an individual is included if he/she has the option of withdrawing a lump sum even though he/she is not eligible for periodic payments. The value of the asset equals the amount that is currently available (i.e., the total fund value less any penalties and/or applicable fees.
If an individual is eligible for periodic retirement benefits, the fund is excluded. Payments may be counted as unearned income.
Section 4.36: Promissory Notes and Mortgages – countable for SSI-Related categories
A. Policy applicable to all SSI-Related categories including residential care and long term care -
A mortgage is a pledge of property to a creditor as security for the obligation or repaying a debt (note).
A note is a written promise to pay or repay a specific amount of money at a stated time. The note specifies conditions such as the amount to be paid, frequency of payments and interest rate.
The note, to be enforceable, and therefore to be of any value, needs to be signed by the debtor and needs to identify, in a complete and precise manner, the obligations to repay.
The presumed value of the note is the principal to be repaid minus any repayments on principal that have been made.
The presumed value can be refuted by obtaining a statement from two sources in the business of buying notes, such as a mortgage company. The statement should identify the amount the source would presently pay for the note and describe the basis for that amount.
The current value of the note then becomes the current sale value. If different sale values are obtained, the higher amount will be used.
B. Policy applicable to long term care:
A transfer of assets occurs when the current sale value of the note is established at less than the presumed value. The amount of the transfer is the amount by which the presumed value exceeds the current sale value. The date of the transfer is the date the note was signed by the debtor. (See Part 15 for treatment of asset transfers.)
Funds used to purchase a promissory note, loan or mortgage can be considered a transfer of assets (see Part 15) unless the note, loan or mortgage:
(1) has a repayment term that is actuarially sound (as determined in accordance with actuarial publications of the Social Security Administration, found online at: http://www.ssa.gov/OACT/STATS/table4c6.html).
(2) provides for payments to be made in equal amounts during the term of the loan, with no deferral and no balloon payments made; and
(3) prohibits the cancellation of the balance upon death of the lender.
In the case of a promissory note, loan or mortgage that does not meet the conditions in (1), (2), and (3). above, the value of the note, loan or mortgage to be considered in determining the amount of the asset transfer shall be the outstanding balance due as of the date of the individual's application for Medicaid.
Section 4.37: Property used for home consumption - excluded for SSI Related categories
All property and equipment used to produce goods or services for home consumption. This includes garden plots, wood lots and livestock.
Section 4.38: Property used to produce income - excluded for SSI-Related categories
Property and equipment used in the production of income includes real property, boats, trucks, machinery and livestock. This also includes garden plots, wood lots and rental property that are income producing and liquid assets used as part of a business or trade.
A. With eligibility decisions effective 3/1/06, income producing property and equipment can be excluded as a countable asset as long as, after three years of operation, the property produces countable income that equals or exceeds .22%, which is the average interest rate for a twelve month Certificate of Deposit (CD) at banks in Maine
(1) Countable income is income that is produced by the property and/or equipment as determined by the MaineCare rules for treating income (See Part 17, Section 3.4.46).
(2) To determine if the countable income equals or exceeds .22%:
(a) Multiply .22% by the fair market value of the property and/or equipment minus encumbrances.
(b) Countable income must at least equal the result in (A(2)(a)) in order for the property and/or equipment to be excluded as an asset.
(3) If the countable income has changed considerably in any year, countable income is averaged for the last three years.
(4) The test for income producing property to be an excluded asset is applied only after the property and/or equipment has three years of operation.
B. Income producing property is excluded as a countable asset regardless of the annual rate of return if:
(1) The property cannot be used due to circumstances beyond the control of the individual and resumption of income production is likely.
(2) The property cannot be used due to the inability of the individual to use the property for up to twenty-four months.
(3) The individual is temporarily disabled and resumption of income production is likely.
(4) The property has not been in operation or production for three years or more.
(5) The owner is making good faith efforts to sell the property at a reasonable price.
Section 4.39: Radiation Exposure Compensation Act – included for SSI-Related categories
Money received under the Radiation Exposure Compensation Act for injuries or death resulting from radiation due to nuclear testing and uranium mining.
Section 4.40: Real Property
With the exception of the exclusions below real property is a countable asset.
A. All real property may be excluded if:
(1) it is up for sale at fair market value with a Realtor or actively being advertised by the owner in the geographic area of the property. If reasonable offers are turned down, no exclusion will be given. A reasonable offer is one, which reflects the price on the open market given the condition and location of the property.
(2) two different knowledgeable sources in the geographic area agree that the property cannot be sold due to a specific condition.
(3) it is held in Joint Tenancy or Tenants in Common with others who refuse to sell the property. A statement from the joint owner is required or documented evidence that such a statement was asked for but not provided.
(4) it meets the criteria of Income Producing Property defined in Section 4.38 above.
B. Primary Residence
(1) Policy applicable to SSI-Related MaineCare categories, including residential care and long term care:
The home which the individual considers their primary residence and the land and all buildings on that land are exempt. This exemption also applies to any adjoining land as long as it is not separated by real property owned by others. Presence of any easement, road, waterway or other natural boundary does not change the exemption.
The home is exempt during periods of temporary absences of the individual, spouse or dependent as long as they indicate their intent to return. (i.e. nursing home care, boarding home, hospitalization, visiting, etc.) Except for visiting, a written statement of intent to return must be submitted. If the client is unable to make this statement, someone acting on the individual's
behalf, such as the individual's guardian, conservator or holder of Power of Attorney may do so.
Once a declaration of intent is made it is valid until an intent not to return home is declared. At that time the home would become a countable asset on the first day of the month after the month in which the declaration is made.
The home may also be exempt if an individual moves out of his or her primary residence, without the intent to return, if he/she is fleeing the home due to domestic violence.
Note: Except for migrant workers (Part 2, Section 4), when a primary residence is located out of state, it cannot be exempted as a countable asset on the basis of an intent to return home. This intent to return to an out of state residence is inconsistent with the residence requirement which is that the individual be living in Maine and intend to remain here.
The home is exempt if occupied by the spouse or dependent of the individual. A dependent is someone who is financially or medically dependent on the individual. This person is or could be claimed as a dependent for IRS purposes.
(2) Policy applicable to Long Term Care
An individual shall not be eligible for long term care assistance if the individual's equity interest in their primary residence exceeds $750,000. This rule is also effective for re-determinations of eligibility made for those applicants whose initial application was on or after 1/1/06.
To determine the equity interest an individual has in their primary residence, consider the following:
(a) The Department needs to see a statement of fair market value such as a recent appraisal from an individual or company licensed to do so.
(b) The amount of an individual's equity interest in their home is equal to the current market value of the home minus any encumbrances, such as a mortgage or other loan that is secured by the home. (Not including a home equity line of credit that has not been utilized.)
(c) A reverse mortgage or a home equity loan outstanding on the property would decrease the equity, but The Department must examine the mortgage or home equity note to see if there has been a transfer of assets.
(d) The Department must see loan documentation to verify that it is a valid transaction with a company in the business of providing home loans or a private individual.
(e) This rule does not affect an individual's eligibility for community MaineCare services if otherwise eligible.
The rule does not apply if the spouse of the individual, or dependent, or disabled child of the individual is lawfully residing in the home.
C. For real property not exempted above the equity value of that property is counted. The value of real property is established by statements from two real estate appraisers or town tax valuation adjusted to 100% valuation rate. If jointly owned the countable asset is the proportion of ownership interest in the real property.
D. Proceeds from the sale of an excluded home will be excluded for up to 3 months from the date of receipt, provided all the proceeds are intended to be used and are, in fact, used to purchase another home, which is similarly excluded.
Example
A piece of land is left to an individual and his two sisters. Although there are three owners, the will indicated that one half of the property is owned by the individual. Therefore, one half of the equity becomes a countable asset unless otherwise excluded.
Section 4.41: Relocation assistance - excluded for SSI-Related categories
Payments made under Title II of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970.
Section 4.42: Reparation Payments – exclude for SSI - Related categories
Japanese Restitution Payments and German Reparation Payments are excluded.
Section 4.43: Replacement of an excluded asset – excluded for SSI - Related categories
Cash received or in-kind replacement received to replace or repair an excluded asset that is lost, stolen or damaged is excluded for a period of nine months. An additional nine months can be given when circumstances beyond the individual's control prevented the replacement or repair of the asset.
Example
The individual has a motor vehicle that was excluded as his primary vehicle under Section 4.54 of this Part. The vehicle was involved in an accident. The insurance company gives the individual a check to replace the vehicle. The individual has nine months in which to purchase another vehicle or repair the damaged one. If at the end of the nine month period the individual still has the money, it will be counted against the asset limit.
Section 4.44: Reverse Mortgage – excluded for SSI Related categories
Proceeds from a reverse mortgage are treated as proceeds of a loan and are not income. Any proceeds available in the month following the month of receipt are a countable resource. This arrangement allows the homeowner to borrow, via a mortgage contract, a percentage of the appraised value of his/her home equity.
The homeowner receives a periodic payment (or a line of credit) which does not have to be repaid as long as the borrower lives in the home. In most reverse mortgages the original loan does not have to be repaid until the homeowner dies, sells the home, or moves.
Section 4.45: Ricky Ray Hemophilia Relief Fund Act – excluded for SSI-Related categories
Payments received under the Ricky Ray Hemophilia Relief Fund Act of 1998. Interest income generated on these payments is countable income and any accrued interest is excluded as an asset. These payments are not subject to special rules on trusts or transfer of resource penalty. Payments are not counted in determining cost of care.
Section 4.46: Savings Bonds – countable for SSI-Related categories
These are countable to the extent of their current cash value. New bonds have no cash value for six months from the date of issue.
If they are jointly owned, the amount to be counted is based on the proportion of ownership interest. If the joint owners (indicated by "and" on the bonds) refuse to sell, then the bonds are unavailable as an asset to the assistance unit.
Section 4.47 Savings Exclusion - excluded for SSI-Related categories, except State Supplement
Up to $8,000 of savings for an individual, $12,000 for an assistance unit of two or more. Any amount over the excluded amount is counted toward the asset limit. Savings is defined as an account which earns interest or dividends except that a checking account does not need to earn interest/dividends. "Savings" includes:
savings or checking account including those in a credit union;
IRA;
Keogh;
available cash value of an annuity;
stocks;
bonds;
mutual funds; and
cash surrender value of life insurance.
The $8,000/$12,000 exclusion applies to all accounts subject to the exclusion. The exclusion is not applied to each account.
Section 4.48; Self-Support Plans for Blind or Disabled Individuals - excluded for SSI Related categories
Any asset necessary to carry out an approved plan for achieving self-support for a blind or disabled individual is excluded. The plan must be approved by the Bureau of Rehabilitation Services or the Social Security Administration.
Section 4.49: Stepparent Assets – excluded for SSI-Related categories
Assets owned solely by the stepparent are excluded.
Section 4.50: Stocks, Bonds and Mutual Fund Shares - included in SSI-Related categories
The value of these assets is determined by multiplying the number of shares by the current value per share. Since the amount indicated on the certificates may be less than actually owned (due to stock splits and reinvestment of dividends) it is important to establish, with the company or broker, the actual number of shares.
If the shares are owned jointly with others (other than the spouse) then the amount of the countable asset is based on the proportion of ownership interest the individual or couple has.
If signatures are required by the other joint owners, in order for the shares to be sold and the joint owners refuse to sell, then the value of these shares is unavailable as an asset to the assistance unit.
If a decision is made to sell the shares, the value is excluded from the time a formal request is made until the proceeds of the sale are dispersed to the individual or couple by the company or broker.
Section 4.51: Supplemental assistance – included for SSI-Related categories
Assistance such as General Assistance, provided by public or private agencies to help recipients and applicants meet emergency situations.
Section 4.52: Susan Walker Settlement – excluded for SSI-Related categories
Payments made from any fund established pursuant to a class settlement in the case of Susan Walker v. Bayer Corp., et al, and payments made pursuant to a release of all claims in a case that is entered into in lieu of the class settlement.
When payments are made in lieu of a class settlement, the agreement must be signed by all parties on or before 12/31/97 or 270 days after the date on which a release is first sent to the persons to whom the payment is to be made.
Section 4.53: Trusts – partially excluded for SSI-Related categories
A "trust" includes any legal instrument or device that is similar to a trust.
There are special provisions for the treatment of assets placed in a trust. The term "asset" includes income as well as resources. Application of the trust provisions govern the treatment of assets in the trust.
A payment from a trust is any disbursal from the corpus of the trust or from income generated by the trust. A payment may include cash as well as non-cash or property disbursements, such as, the right to use and occupy real property.
For trusts established on or before 8/10/93 for services provided on or before 4/30/94 refer to Appendix H.
The following rules are effective for trusts established on or after 8/11/93 for Medicaid provided on or after 5/1/94.
A. Trusts established by the individual:
(1) Special rules apply to the treatment of trusts established by the individual. These rules apply without regard to:
(a) the purposes for which the trust is established;
(b) whether the trustees have or exercise any discretion under the trust;
(c) any restriction on when or whether distributions may be made from the trust; or
(d) any restrictions on the use of distributions from the trust.
(2) A trust is considered to be established by an individual if the assets of the individual were used to form all or part of the corpus of the trust and if any of the following entities and/or individuals established the trust other than by will:
(a) the individual;
(b) the individual's spouse;
(c) a person, including a court or administrative body, acting at the direction or upon the request of the individual or the individual's spouse or with legal authority to act in place of or on behalf of the individual or the individual's spouse.
When a trust corpus includes assets of someone other than the individual, these rules apply only to the individual's portion of the trust assets. The individual's countable income and resources must be prorated based on the proportion of the individual's assets in the trust to those other persons.
(3) When a trust is set up as of 3/1/06 as part of a negotiated settlement of the individual or his/her spouse, the trust is considered to be set up by the individual and is not a third party trust. A 'negotiated settlement' is one in which the individual as defined above and others confer, bargain, or discuss with the view of reaching an agreement. Examples of a negotiated settlement are: a divorce or an insurance settlement. Any funds transferred to a trust as a result of a negotiated settlement, are considered to be funds that are owned by and transferred by the individual.
(4) Revocable Trusts - are trusts which can, under state law, be revoked by the individual or an entity in A(2) of this section or a court. It includes a trust which ends if some action is taken by the individual.
In the case of a revocable trust:
(a) the entire corpus and the income produced by the corpus of the trust is considered a resource available to the individual;
(b) payments from the trust to or for the benefit of the individual are considered income to the individual; and
(c) any other payments from the trust are considered to be assets that are transferred. The look back period for transfers is sixty months (See Part 15, Section 1.1).
When real property is transferred to a revocable trust, it is considered to be available to the individual because it is accessible.
Effective with transfers on or after 9/1/02, a primary residence, while an available asset, cannot be exempted on the basis of an "intent to return" or as the residence of the community spouse because the property is not owned by the individual.
Similarly, property used to produce income is an available asset but is not exempted as income producing property because it is not owned by the individual.
(5) Irrevocable Trusts - are trusts which cannot in any way be revoked by the individual or entity in A(2) of this section.
In the case of irrevocable trusts:
(a) if there are any circumstances under which payment from the trust could be made to or for the benefit of the individual including a payment at a future date, the following rules apply:
(i) the portion of the corpus that could be paid to or for the benefit of the individual is a countable resource to the individual. The income produced by this portion of the corpus is also a countable resource to the individual.
(ii) payments actually made from the corpus (or from income produced by the corpus) to or for the benefit of the individual are income to the individual.
(iii) payments actually made from the corpus (or from income produced by the corpus), but not to or for the benefit of the individual, are a transfer of assets. All payments made on or
after 2/8/06 are subject to a sixty month look back period (See Part 15).
(b) if no payment could be made under any circumstances to or for the benefit of the individual the following rules apply:
(i) the portion of the corpus from which no payment could be made to or for the benefit of the individual is considered to be an asset that has been transferred.
Income on this portion of the corpus from which no payment could be made to or for the individual is also considered to be an asset that has been transferred. The look back period is sixty months (See Part 15).
(ii) the date of the transfer is the date of the establishment of the trust or, if later, the date on which payment is unavailable to the individual.
(iii) the value of the transfer includes any payments made after the trust is established or payment to the individual is unavailable.
6. Exemptions
The following trusts are exempt from the provisions of A(5) of this section. No transfer is considered to take place as a result of establishing the trust, except as indicated in (b) below relating to pooled trusts. The income and resources considered available to the individual are those made available by the trust.
(a) a trust containing the assets of an individual under age 65 who does or would meet the SSI criteria for disability if:
(1) the trust is established for the sole benefit of the individual by the individual's parent, grandparent, legal guardian or a court; and
(2) the state will receive all amounts remaining in the trust upon the death of the individual up to an amount equal to the total Medicaid paid on behalf of the individual after due payment of any legal obligations of trust.
This trust is considered to be established for the "sole benefit of" the individual if no other individual or entity can benefit from the assets transferred in any way whether at the time the trust is established or at any time in the future. A trust may provide for reasonable compensation to trustees to manage the trust and for beneficiaries after Medicaid has been reimbursed.
The trust may contain assets of individuals other than the disabled individual.
This exemption remains once the individual turns age 65 as long as there are no changes in the terms of the trust once the individual attains age 65. Any assets added as of age 65 are not subject to exemptions under (E) above.
(b) a trust containing the assets of an individual who does or would meet the SSI criteria for disability if:
(1) the trust is established and managed by a non-profit association;
(2) a separate account is maintained for each beneficiary of the trust but for purposes of investment and management of funds, the trust pools these accounts;
(3) the accounts in the trust are established solely for the benefit of the disabled individual by the individual or the individual's parent, grandparent, legal guardian or by a court; and
(4) to the extent that amounts remaining in the beneficiary's account upon the death of the beneficiary are not retained by the trust, the trust pays to the state an amount equal to the total amount of Medicaid paid on behalf of the beneficiary after due payment of any legal obligations of the trust.
However, any assets added to the trust as of age 65 may be subject to a transfer penalty (see Part 15).
A trust is considered to be established for the "sole benefit of" the individual if no other individual or entity can benefit from the assets transferred in any way whether at the time the trust is established or at any time in the future. A trust may provide for reasonable compensation to trustees to manage the trust and for beneficiaries after Medicaid has been reimbursed.
An individual age 65 or older is not automatically considered to meet the SSI criteria for disability. This must be determined as in Part 6, Section 4.3.
(c) trusts that are set up with retroactive SSI benefits awarded under the Sullivan v. Zebley, 493 U.S. 521 (1990) decision.
B. Trusts Established for the Individual by Someone Else
With trusts that are set up for the individual by someone else including those that are set up by will, trust funds are available assets unless the terms of the trust make them unavailable.
If the trust is irrevocable, that is, no member of the assistance unit or any responsible relative residing in the home has the power to revoke the trust arrangement or change the name of the beneficiary, what is available to the client is what is made available according to the terms of the trust.
1. The terms of the trust may specify the amount/frequency and/or purposes for which the funds may be used or this may be left to the discretion of the trustee(s). The terms of the trust may use a combination of both trustee discretion and specific fund usage.
2. Of the funds left to trustee discretion, what is available to the client is whatever the trustee makes available.
3. Funds made available are considered as income or assets in accordance with applicable Medicaid eligibility rules for the situation.
4. If the terms of the trust restrict withdrawal by written approval of a judge of the courts, regular withdrawals will be treated as any other income. Irregular withdrawals, in order to be disregarded, must be used to supplement the needs of the person for whom the trust is drawn up.
Examples
(a) An individual has a trust fund that was established upon the death of his parents based on their will. From this he is to receive $500 from the interest each month and $10,000 every three years to buy a new vehicle. The monthly payments are income. The $10,000 is used to purchase an excluded asset (the old vehicle is traded in to purchase the new one).
This trust is irrevocable in accordance with the provisions above. The terms of the trust specify the amount, frequency and for part of the payments (the $10,000) the purpose. Medicaid policy treats interest payments as income and excludes the vehicle as an asset.
(b) A trust was set up for the individual by his father who is deceased. The individual is to receive $200 per month for as long as the fund lasts. The fund currently has $140,000. The individual can get all the funds in the trust if there is an emergency.
The $200 per month is considered income as long as this represents interest income. The remainder of the fund is considered an asset (currently $140,000) since it can be accessed by the individual.
(c) A trust is set up for the individual by her grandmother. It is irrevocable and the trustee has full discretion in disbursement of the funds (totaling $75,000) based on the needs of the individual.
Since the trust is irrevocable, what is considered available to the individual is whatever the trustee, in her discretion, makes available.
Section 4.54: Vehicles
The following exclusions are applied in the manner most advantageous to the individual:
Exclude one vehicle which is used to provide transportation for the household, such as passenger cars, trucks, boats and special vehicles such as motorcycles, snowmobiles, animal drawn vehicles and even animals. This includes vehicles that are unregistered, inoperable or in need of repair.
A second vehicle is totally excluded regardless of value if it is:
1. needed for employment or to seek employment;
2. needed to secure medical treatment;
Note: This exclusion does not apply to individuals residing in a nursing or residential care facility. These facilities are required to provide Medicaid eligible individual with any transportation needed to secure medical treatment.
3. modified for operation by a person with a disability or is modified for the transportation of a person with a disability; or
4. necessary because of climate, terrain, distance, or other similar factors, or to provide transportation to perform essential daily activities.
In order for an individual to have a second vehicle for reasons 1-4 above, they must show a need for two separate vehicles.
Examples
An individual lives on an island, leaves one car on the island and one car on the mainland to avoid having to transport a car on the ferry.
An elderly applicant has two cars. An adult (or minor) child who lives with her uses one of the vehicles for work. The applicant needs the other vehicle to secure medical treatment.
C. If no vehicle is totally excluded, the fair market value in excess of $4500 is counted as an asset. The fair market value is established by using the "trade-in value" listed in the "National Automobile Dealers Association's (NADA) Used Car Guide". The individual may prove that the vehicle is worth less than the value listed by NADA by providing verification from two reliable sources.
Note: This exclusion involves the fair market value and not the equity in the vehicle. For this reason the individual may wish to exclude the vehicle with the highest value and not the one with the most equity.
D. Unless excluded, the equity value of any other vehicle is counted. For business vehicles see Section 4.37 of this Part.
Examples
Sally and Jim have two vehicles that are not excluded. They have a Buick worth $7000 (FMV) on which they owe $6000. They also have a Ford worth $5000 (FMV) that they own free and clear.
If the Buick is partially excluded they would be over assets.
$7000 (FMV/$1000 equity) - $4500 exclusion = $2500
$5000 (FMV and equity) Ford = $5000 countable
This results in countable assets of $7500 from these two vehicles.
If the Ford is partially excluded only $1500 would be counted against the asset limit.
$5000 (FMV and equity) Ford - $4500 exclusion = $500
$7000 (FMV/$1000 equity) Buick = $1000 countable
2. Mrs. Johnson has a five year old car that is not totally or partially excluded. The fair market value (FMV) is $6000. She still owes $5000 on this.
$6000 (FMV) - $4500 exclusion = $1500 countable asset
Even though the equity is only $1000, $1500 is counted as an asset, because of the fair market value.
Section 4.55: Veterans Payments for Vietnam Veterans’ natural children: excluded for SSI-Related categories
VA monthly payments made to or on behalf of Vietnam veterans' natural children regardless of their age or marital status for any disability resulting from spina bifida suffered by such children are excluded from income and resources. Interest earned on unspent payments is not excluded.
Section 4.56: Volunteer Service Programs – excluded for SSI-Related categories
Any payment whether cash or in-kind made under the Domestic Volunteer Service Act Public Laws (93-113)
A. Title I - Corporation for National and Community Service (CNCS)(formerly ACTION)
AmeriCorps State and National, AmeriCorps NCCC, and AmeriCorps* VISTA
University Year for Action (UYA)
Special and Demonstration Volunteer Programs
B. Title II - National Older American Volunteer Programs which now include
Foster Grandparent Program
Senior Companion Program
Retired Senior Volunteer Program (RSVP)
C. Title III - (repealed and now contained within the Small Business Act)
Service Corps of Retired Executives (SCORE)
Active Corps of Executives (ACE)
Attributed Income: Attributed income means the amount of tips reported to IRS by large restaurants. It is based on a formula and may not reflect the amount actually received by the employee. The attributed tips are shown on the W-2. It is the responsibility of the employer to keep a daily log of tips actually received. The log of tips will be used to determine the amount of tips countable as income. If there is reason to believe that tips are being underreported, the individual and, with the individual's permission, the employer or collateral sources should be contacted.
Contract Income: Contract income means income received by employees for a set period of time. It may be a full year or for a shorter term, such as school teachers. Divide the most recent contract income by the length of the term of the contract to determine the monthly average.
Corporation – C: C Corporation means a business that has been incorporated as a C corporation. The income of the corporation is owned by the corporation and is not countable to the individual unless it is distributed to the individual as income.
Corporation – LLC, Sub-S or S: LLC, Sub-S or S Corporation means a business that has been incorporated as an LLC, Sub-S or S corporation. The income of these corporations is owned by the individual.
Earned Income: Earned income means income received in payment for the labor or services of an individual. It includes cash payments, wages, salaries, commissions, sheltered workshop wages, and profits from self-employment, severance, contractual payments and deferred compensation.
Fluctuating Income: Fluctuating income means income received by an employee in different amounts each pay period or at irregular intervals. The differences may be due to the number of hours worked, hourly wage rate, output (such as piecework and some types of commissions) or the number of employers (such as baby sitting). In these cases, the individual's income must be examined over the broadest period of time possible. If the "year to date" (YTD) figure is an accurate reflection of the current situation, divide the amount by the number of weeks the YTD covers and budget this average as regular weekly income. If the YTD is not accurate, the average weekly income should be based on a review of income
representative of the current situation. If there are unusually high or low weeks, then an exploration of how likely they are to continue must be made and their inclusion or exclusion documented.
Lump Sum Income: Lump sum income means a non-recurring payment received as a result of an accumulation of income or windfall income. Some examples are: retroactive portions of Social Security, Workers’ Compensation, Unemployment, Disability, VA or other benefits, pay raises, inheritances, and lottery winnings. Lump sum income is treated as income in the month of receipt and as an asset (if applicable) in the following month. See Section 4.40 of this Part for SSI-Related eligibility group exclusions to income and Part 16, Section 4.31 for SSI-Related eligibility group exclusions as an asset.
Partnership: Partnership means an agreement between two or more individuals who share profit and loss in a business. The specific terms of a partnership determine whether income and assets are owned by the individual unless the business is a C, LLC, Sub-S or S Corporation.
Regular Income: Regular income means income received by an employee at regular intervals and in the same amount each pay period. This includes income of salaried employees and hourly wage earners who work the same number of hours at the same hourly pay each week. The amount of income to be used is based on the frequency it is received.
Seasonal Income: Seasonal income means income that is not received year round. During the off-season, no income is received from the seasonal occupation. Seasonal income is budgeted for the period that the individual is actually working. To determine an anticipated amount, use the income received for the most recent season of employment, taking into consideration any expected increases or decreases in income.
Self-Employment Income: Income received by a self-employed individual who is engaged in a business enterprise. This includes independent contractors, franchise holders, owners / operators, farmers, people who produce and sell a product, and service-type businesses. If the most recent tax return is available showing the profit or loss, and there have been no major changes, then the monthly gross income is determined by dividing the net profit or loss amount by twelve. The net profit or loss can be found on the appropriate IRS schedule such as the Schedule C. If a tax return is unavailable, the profits have changed considerably, or the business was started after the beginning of the tax year, the most detailed records showing the net profit should be used. The records may include ledger sheets, receipt books, self-employment work sheets, or any reasonable form of documentation. All deductions allowed by the Internal Revenue Service, including depreciation, may be used.
Some sources of income, though exempt from taxation, are counted in MaineCare. An example is Difficulty of Care payments. The amount that is counted will be the gross receipt minus expenses associated with the production of this income. The net loss from one source of self-employment is deducted against other earnings including other sources of self-employment income of the individual, his/her spouse or other members of the assistance unit. This applies whether a couple filed a joint income tax return or separate returns, and regardless of which member of the assistance unit incurred the loss. This includes, in SSI - Related categories, the ineligible spouse and parents of disabled children.
Sole Proprietorship: Sole Proprietorship means a business owned by the individual. The business is not incorporated under IRS rules. The individual owns all the assets and income of the business.
Unearned Income: Unearned income means income received for something other than payment for the labor or services of an individual. It includes Social Security, Veteran's Benefits, pensions, dependent's allotments, maintenance agreements, contributions, support payments, annuities, dividends, interest, or unemployment compensation. Service charges are not deductible in determining dividend or interest income.
Section 2.1: MAGI-based Income
MAGI-based income is defined as income calculated using the same financial methodologies used to determine modified adjusted gross income as defined in section36B(d)(2)(B) of the Internal Revenue Code, [“Modified adjusted gross income” means adjusted gross income increased by – (a) Any amount excluded from gross income under section 911 of the Internal Revenue Code; (b) Any amount of interest received or accrued by the taxpayer during the taxable year which is exempt from tax; and (c) An amount equal to the portion of the taxpayer’s social security benefits (as defined in the Internal Revenue Code Section 86(d) which is not included in gross income under section 86 for the taxable year”], with the following exceptions:
An amount received as a lump sum is counted as income only in the month received;
Scholarships, awards, or fellowship grants used for education purposes and not for
living expenses are excluded from income;
American Indian/Alaska Native exceptions. The following are excluded from income:
Distributions from Alaska Native Corporations and Settlement Trusts;
Distributions from any property held in trust, subject to Federal restrictions, located within the most recent boundaries of a prior Federal reservation, or otherwise under the supervision of the Secretary of the Interior;
Distributions and payments from rents, leases, rights of way, royalties, usage rights, or natural resource extraction and harvest from:
(a) Rights of ownership or possession in any lands located within the most recent boundaries of a prior Federal reservation, or otherwise under the supervision of the Secretary of the Interior; or
(b) Federally protected rights regarding off-reservation hunting, fishing, gathering, or usage of natural resources;
Distributions resulting from real property ownership interests related to natural resources and improvements :
(a) Located on or near a reservation or within the most recent boundaries of a prior Federal reservation; or
(b) Resulting from the exercise of federally-protected rights relating to such real property ownership interests;
Payments resulting from ownership interests in or usage rights to items that have unique religious, spiritual, traditional, or cultural significance or rights that support subsistence or a traditional lifestyle according to applicable Tribal Law or custom;
Student financial assistance provided under the Bureau of Indian Affairs education programs.
Section 2.2 Income Conversion Methodology
When income is received once a month, the taxable income is the amount to be counted.
When income is received twice a month (usually the first and fifteenth of each month), multiply the taxable wages by two.
When income is received biweekly, multiply the taxable wages by 2.15.
When income is received weekly, multiply the taxable wages by 4.3.
Section 3.1 Non-MAGI-Based Income
This is defined as the gross amount of income before any deductions (including but not limited to payroll deductions).
Section 3.2 Income Conversion Methodology
When income is received once a month, that is the monthly gross income.
When income is received twice a month (usually the first and fifteenth of each month), multiply the gross income by two.
When income is received biweekly, multiply the gross income by 2.15.
When income is received weekly, multiply the gross income by 4.3.
Section 3.3 Garnishment
Garnishment is when income is withheld by administrative or court order to pay a creditor or overpayment by a government agency.
Income is counted even if it is garnished, unless the garnishment was premised on an overpayment of governmental benefits and the individual was receiving Medicaid at the time of the overpayment occurred. In such case the garnished amount is excluded in determining the amount of income.
Section 3.4: Treatment of Income
Section 3.4.1: Adoption Assistance – included
Adoption Assistance Payments
Section 3.4.2: Agent Orange Settlements – excluded
Agent Orange Settlements as provided for under PL 100-687 and 101-201.
Section 3.4.3: ASPIRE Payments – excluded
Exclude all payments made by the ASPIRE-TANF Program.
Section 3.4.4: Burial Funds – excluded
Interest on funds designated for burial or interest earned on the value of agreements representing the purchase of burial spaces (provided the burial spaces are excluded from assets and provided the interest is left to accrue) as long as there is no break in the receipt of assistance. (See Part 16, Section 4.6).
Section 3.4.5: Cafeteria Plans – partially excluded
Portions of IRS Section 125 payments retained by the employer as payment for benefit items chosen by the employee from the Section 125 menu or “cafeteria plan” are excluded.
Section 3.4.6: Child Support – included
Child support payments are income to the child(ren) for whom the payments are intended. This rule applies even if the child does not reside with the parent receiving the payment or if the payments include arrearages (past due amounts) or if the "child" for whom the payments are intended is now over age 18.
Section 3.4.7: Children eligible for SSI - Related Eligibility Groups
The following exclusions from the child’s income apply:
The first $1640 per month of earned income, not to exceed $6600 per calendar year, for a student attending school regularly as defined by the learning institution.
One-third of child support, including a military allotment. The payment may be voluntary or court ordered.
Section 3.4.8: Combat Pay – excluded
Hostile fire allotment paid by the Uniformed Services.
Section 3.4.9: Commercial Transportation Tickets – excluded
The value of a domestic commercial transportation ticket received as a gift by an individual (or his or her spouse) and not converted to cash will be excluded in the determination of the individual's income. Domestic travel is defined as travel among the 50 States, the District of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.
Section 3.4.10: Compensated Work Therapy Program – excluded
Earnings received under the Compensated Work Therapy Program established by Title 38 U.S.C. Section 1718 and administered by the Department of Veteran Affairs. Monies received under this program are considered a social service benefit and not to be considered countable income.
Section 3.4.11: Cost of Living Adjustment (COLA) – excluded for most purposes – see (B) below
There are two types of income exclusions associated with annual Cost of Living Adjustments. One exclusion is used for any COLA taking effect in January, February
and March (See Section 4.11.1 below), while the other only applies to Social Security and Railroad Retirement benefits (See Section 4.11.2 below).
Cost of Living Adjustments taking effect January, February and March excluded
All annual Cost of Living Adjustments (COLA) that take effect in January, February or March, will be excluded for any individual in a Medicaid coverable group whose income limit is based on the FPL. This exclusion will remain in effect until the month following the month that the new annual Federal Poverty Levels (FPL) are published in the Federal Register. This exclusion also applies to individuals covered by DEL, Maine Rx, Cub Care, and Medicare Buy-In.
Examples
(1) An individual is an ongoing MaineCare recipient. He received a Social Security COLA in January. The Federal Poverty Levels are published in February. The COLA is excluded until March. The cost of living increase is counted in the budget as of April.
This exclusion also applies in determining retroactive coverage.
(2) An individual applies in April. The poverty levels were published in February. The Social Security COLA received in January will be excluded for the retroactive months of January, February and March.
This exclusion does not apply to individuals covered under Home and Community Bases Waivers and Medically Needy since the Federal Poverty Levels are not used in determining their eligibility.
Social Security and Rail Road Retirement Cost of Living Adjust. (COLA) - excluded for SSI - Related eligibility groups (not excluded for State Supplement)
If the COLA results in ineligibility for individuals covered under SSI - Related eligibility groups, the amount of SSA / RR received prior to the most recent COLA is used to determine eligibility.
This applies to individuals:
(a) covered under SSI – Related eligibility groups using the Federal Poverty Level as an income limit.
(b) covered under Medicare Buy-In.
This applies to individuals in the following living arrangements when comparing their income to the Medicaid rate for the facility:
Awaiting Placement for Residential Care,
residing in Cost Reimbursed Boarding Homes
in Residential Care Facilities, and
in Adult Family Care Homes whose income goes over the Medicaid rate.
This exclusion is not used to determine the cost of care for these facilities.
Example
A disabled individual is eligible and receiving Medicaid. In January he receives his SSDI COLA of $35.00. This increase puts him over the FPL in effect for that month.
The increase will not be counted until the month following the month the new FPL’s are published.
In February the new FPL’s are published. The individual’s countable income is still greater than the new FPL level because of the COLA received in January. The COLA of $35.00 received in January will be excluded to determine the individual’s countable income.
This exclusion ends if:
(a) individual loses Medicaid coverage for any reason for three consecutive months.
To determine if an individual has lost Medicaid coverage for three consecutive months the retroactive period of a reapplication must be taken into account. If including the retroactive months the individual was not closed for three consecutive months, the disregard will continue.
Example
An individual with a COLA disregard closes in June. He reapplies in November. By applying the COLA disregard in the retroactive month of August, September and October the individual is eligible. The individual will keep the COLA disregard for retroactive and prospective months.
the individual’s countable income, including the disregarded SSA/RR COLA, is below the FPL.
The individual may again be eligible for the disregard in later years if they again become ineligible due to COLA changes in SSA / RR and FPL.
If the individual receives added or increased income from a source other than SSA / RR at the time of the COLA adjustments, this disregard can be used only if ineligibility is caused by the change in SSA/RR income.
When budgeting for a couple this disregard applies to the SSA / RR of both individuals even though disregarding the COLA increase of only one member of the couple would result in keeping Medicaid coverage for the couple.
Section 3.4.12: Difficulty of Care Payments – included
A source of income that although is exempt from taxation is included.
Section 3.4.13: Disability Insurance Payments – excluded
All payments made on behalf of an individual under a credit life or credit disability insurance policy (i.e. payment of car payments or mortgage when you become disabled).
Section 3.4.14: Disabled Widowers Benefits – excluded
Social Security benefits received by some disabled widow(er)s who are not receiving Medicare (See Part 6, Section 5.2.9).
Section 3.4.15: Disaster Relief – excluded
In-kind or cash assistance received as the result of a disaster declared by the President of the United States.
Section 3.4.16: Disaster Unemployment Assistance – excluded
Disaster Unemployment Assistance authorized in P.L. 100-707,42 U.S.C. Section 5155(d) (1988). This is paid to an individual unemployed as a result of a major disaster.
Section 3.4.17: Earned Income Exclusions – partially excluded
Excluded only for persons who are blind
Earned income which is used to meet expenses of producing income by a person who is blind is excluded. This includes earnings excluded by SSI as part of a PASS plan. These expenses include transportation to and from work (in accordance with IRS guidelines or actual cost if not using own car), cost of caring for a guide dog, child-care, licenses, lunches, Braille instruction, professional association dues, income taxes, tools, union dues and computer training.
Excluded for individuals with a disability
Earned income which is used to meet expenses of producing income as part of a PASS plan by a person who is disabled is excluded.
Section 3.4.18: Emergency Assistance – excluded
Section 3.4.19: Emergency Conservation Services Program – excluded
Any assistance provided in cash or in-kind under the Emergency Conservation Services (ECS) Program (PL 93-644, Sections 222 and 95-568) including cash to prevent fuel cut-offs.
Section 3.4.20: Experimental Housing Allowance Program – excluded
Payments made under Annual Contribution Contracts entered into prior to 1/1/75, under Section 23 of the U. S. Housing Act of 1937, as amended.
Section 3.4.21: FmHA Utility Reimbursement – excluded
Section 3.4.22: Food produced for personal consumption by members of the household – excluded
Section 3.4.23: Food Supplement Program (FSP) – excluded
The value of benefits under the Food Supplement Program or food distributed by the Department of Agriculture are excluded.
Section 3.4.24: Foster Care Payments
Included IV-E Foster Care Maintenance Payments – Payments received from the Department or other agencies for foster children in licensed or approved homes who are not part of the assistance unit.
Excluded Foster care payments to a provider of foster care for a child or adult who is not an eligible individual but who is living with an eligible individual and who was placed there by a public or private agency.
Section 3.4.25: General Assistance – excluded
Section 3.4.26: Goods and services – Included
Goods and services not included in the list of basic requirements (See Chart 1.)
Section 3.4.27: Governor Baxter School Compensation – excluded
One time cash payment from the Governor Baxter School for the Deaf Compensation Authority. Interest on this compensation is excluded as income and any accrued interest is excluded as an asset.
Section 3.4.28: Grants, Loans Scholarships
A. Administered by Commissioner of Education – PL 90-575 – Title V
(1) The grants and loans are:
Basic Education Opportunity Grant Program (Pell Grants)
National Direct Student Loan program (Perkins Loans)
Supplemental Education Opportunity Grant Program (SEOG)
Guaranteed Student Loan Program
State Student Loan Program
All excluded for undergraduates, only tuition and fees excluded for graduate students
(2) All other grants/loans/scholarships – exclude tuition and fees and other necessary educational expenses for undergraduates and count for all other students (educational expenses include lab fees, student activity fees, transportation, stationary supplies, books, technology fees, and impairment related expenses necessary to attend school or perform school work.)
(B) Federal College Work Study Program – excluded
Section 3.4.29: Home Based Care Funds – excluded
Section 3.4.30: Home Energy Assistance Program (HEAP) – excluded
Assistance with fuel bills or weatherization assistance received through the Home Energy Assistance Program (HEAP).
Section 3.4.31: Housing – excluded
Value of relocation assistance under the Uniform Relocation and Real Property Acquisition Policies Act of 1970 (PL 91-646 Title II). This does not include payment for the fair market value of the property.
Any interest paid on HUD escrow accounts is not countable income as long as a family is receiving any state, federal or other public assistance for housing and they cannot access this amount. The "Family Self-Sufficiency Program" is a five year program open to all section 8 housing participants which aims to help the family become self-sufficient at the end of the five years. When the account becomes available, it is countable as a resource and/or interest income.
Value of assistance for housing under the Housing Authorization Act of 1976 (PL 94-375) or Housing Act of 1937 as amended by PL 92-213.
Section 3.4.32: HUD Utility Reimbursement – excluded
Section 3.4.33: Individual Development Accounts – excluded
Contributions to an Individual Development Account (IDA). See the asset rule (Part 16) for a definition of an IDA.
Family Development Account (FDA for TANF recipients)
any income used by the individual to fund this account excluded as income.
any asset used by the individual to fund this account is excluded as an asset including up to $10,000 of lump sum income remaining in the month following receipt.
any individual contributions that are matched are excluded as income.
accrued interest on FDA funds is excluded as income or asset.
Withdrawals from these accounts at any time must be used for the following purposes in order for the fund to remain an exempt asset:
expenses for education or job training to attend an accredited or approved post-secondary education or training institution;
the purchase or repair of a home that is the primary residence;
the purchase or repair of a vehicle used for transportation to work or to attend an education or training program;
capital to start a small business for any member of the assistance unit 18 years of age or older;
health care costs of a member of the assistance unit that are medically necessary and that are not covered by public or private insurance;
to address an emergency that may cause the loss of shelter, employment or other basic necessities; or
to address other essential family needs approved by the Department.
When withdrawals are used for any other purpose this will result in the fund being considered a countable asset effective the month of the withdrawal. The TANF Program determines if this condition is met.
Demonstration Project Account (AFIA)
any income of the individual deposited in an AFIA are excluded as income.
any individual contributions that are matched by another party are excluded as income or assets.
accrued interest on AFIA funds are excluded as income or assets.
withdrawal from these accounts is allowable only for certain reasons as determined by the agency authorizing this IDA. These reasons include post- secondary educational expenses, acquiring a residence, or expenditures for operating a business.
Section 3.4.34: Income of those who could be in the household except they are in a medical facility – Included
Income of persons who could be members of the assistance unit except that they are in a hospital, intermediate care facility (ICF) or skilled nursing facility (SNF). In most situations, the income of the individual in the hospital or nursing home is used to determine nursing home eligibility. This also takes place when the individual is in an acute care facility for a period of more than sixty days or immediately upon entering a hospital for a kidney transplant.
Section 3.4.35: Income tax refunds – excluded
Note: Income tax refunds are excluded as assets for 12 months from receipt.
Section 3.4.36: Irregular or Infrequent Income – excluded
Earned or unearned income, from a single source, which is received irregularly (receipt cannot reasonably be expected) or infrequently (no more than once during a calendar quarter). This amount is not to exceed $60.00 per calendar quarter for unearned income and $30.00 per calendar quarter for earned income. This includes small gifts of income such as those received at Christmas, graduation, birthdays or anniversaries.
Section 3.4.37: Job Corp Payments – excluded
Payment by Job Corp for supportive services such as child-care, transportation, medical care, meals and other reasonable expenses are excluded.
Note: All other payments from Job Corp are considered income.
Section 3.4.38 Job Related Expenses – excluded
Reimbursement for job related expenses such as travel or uniforms to the extent that they do not represent a gain or exceed actual expenses.
Section 3.4.39: Loans – excluded
Money borrowed by an individual providing there is clear evidence of an agreement to repay. The proceeds of the loan are not income in the month borrowed, however, they are considered countable assets in the following month.
Written statements from both the individual and the party lending the money must be obtained indicating that the funds are a loan, the amount and the plan for repayment. Without verification of the loan the funds will be considered a gift and treated as a lump sum (See Section 4.41 below).
Section 3.4.40: Lump Sum Income – partially excluded
SSI lump sum payments are excluded income.
SSI or Social Security retroactive payments are excluded as an asset for nine months. After that, any portion remaining becomes a countable asset.
The exception to the month received rule is direct deposits and other electronic transfers of funds. These are counted for the month they were intended to be received even if they are posted early or late.
Section 3.4.41: Native American payments – excluded
Any payments distributed per capita to or held in trust for members of any Indian tribes under PL 92-524, 93-134, 94-540, 97-458 or 98-64.
Receipts distributed to members of certain Indian tribes referred to in Section 5 of PL 94-114, effective 10/17/75, and PL 98-123 and 98-124, effective 10/13/83.
Any income or assets accruing to members of the Passamaquoddy Tribe, the Penobscot Nation and the Houlton Band of Maliseet Indians pursuant to PL 96-420 (the Maine Indian Claims Settlement Act of 1980).
The tax exempt portions of payments made pursuant to PL 93-203, the Alaskan Claims Settlement Act.
Native American payments as detailed in Title 20 CFR, Part 416 Appendix to Subpart K (IV).
Per capita distribution payments, receipts from trust lands and dividend payments to members of various native American and Indian tribes such as Blackfeet, Gros Ventre, Grand River Band, Alaskan Native Claims Settlement Act under the provisions of Distribution and Judgment Funds (PL 92-254 Sections 4, 6, and 7), Receipts from Lands Held in Trust for Indian Tribes (PL 94114, Section 6).
Section 3.4.42: Nazi persecution payments – included
Payments made to victims of Nazi persecution under Public Law 103-286 (Nazi Persecution Victims Eligibility Benefits).
Section 3.4.43: Nutrition and Food Assistance – excluded
The value of supplemental food assistance under the Child Nutrition Act of 1966 (WIC), as amended and the special food services program for children under the National School Lunch Act, as amended (PL 92-422, PL 90-302 and PL 93-150).
Any benefit received under Title VII Nutrition Program for the Elderly, of the Older Americans Act of 1965, as amended by PL 95-478.
Section 3.4.44: Payments to replace income – excluded
All payments made to replace income that has been lost, destroyed or stolen.
Section 3.4.45: Radiation Exposure Compensation – excluded
Money received under the Radiation Exposure Compensation Act for injuries or death resulting from radiation due to nuclear testing and uranium mining.
Section 3.4.46: Rent rebates – excluded
Rebates by any public agency of taxes or rent rebate on real property.
Section 3.4.47: Rental Property Income – included
Net income from rental property is treated as earned income when Income Tax is filed on a Schedule C. It is treated as unearned income if filed in a Schedule E.
Section 3.4.48: Repayment of a loan – excluded
Money received as the repayment of the principal of a loan (including a promissory note) is not income in the month received. Any amount retained in the following
month is considered a countable asset. Money received as interest payments is considered income in the month received.
Example
A couple sells their home and holds a mortgage at 10%. They receive $315 per month as a mortgage payment. Of that amount, $200 is interest and must be counted as income in the month received. The remaining $115 is repayment of the principal and is excluded income for the month. Any portion of the principal remaining in the following month is a countable asset for that month.
Section 3.4.49: Ricky Ray Hemophilia Fund – excluded
Payments received under the Ricky Ray Hemophilia Relief Fund Act of 1998. Interest income generated on these payments is countable income and any accrued interest is excluded as an asset. These payments are not subject to special rules on trusts or a transfer of resource penalty. Payments are not counted in determining a cost of care.
Section 3.4.50: Roomers and Boarders – included
Net income from roomers and boarders is treated as unearned income.
Section 3.4.51: Savings bonds – excluded
Interest on Series E, EEE and H Savings Bonds is not counted as income at any time. When these bonds are redeemed, the interest is a countable asset.
Interest on Series HH Savings Bonds is paid by direct deposit, semi-annually. The interest would be considered unearned income in the month received.
Section 3.4.52: Self Support Plans – excluded
That portion of earned or unearned income needed to fulfill a plan for self-support approved by Vocational Rehabilitation or the Social Security Administration (including PASS plans) for an individual who is disabled or blind.
Section 3.4.53: Selling, replacing or exchanging an asset – excluded
Money received as a result of selling, replacing or exchanging an asset is excluded as income. They are assets that have changed their form.
Section 3.4.54: Senior Community Service Employment Program (SCSEP) – excluded
Community Service Employment is a Program for older Americans authorized under Chapter 35, Title 42 of U.S. Code.
Section 3.4.55: SSI Payments – excluded
SSI benefits received by a spouse, parent or other family member when determining non-nursing care assistance.
Section 3.4.56: Susan Walker Settlement – excluded
Payments made from any fund established pursuant to a class settlement in the case of Susan Walker v. Bayer Corp., et al, and payments made pursuant to a release of all claims in a case that is entered into in lieu of the class settlement.
When payments are made in lieu of a class settlement, the agreement must be signed by all parties on or before 12/31/97 or 270 days after the date on which a release is first sent to the persons to whom the payment is to be made.
Section 3.4.57: TANF – excluded
TANF benefits received by a spouse, parent or other family member are excluded. These people are also not counted as members of the assistance unit during the budgeting process.
Section 3.4.58: VA Benefits for Vietnam veterans’ children with spina bifida – excluded
VA monthly payments made to or on behalf of Vietnam veterans’ natural children regardless of their age or marital status for any disability resulting from spina bifida suffered by such children are excluded from income and resources. Interest earned on unspent payments is not excluded.
Section 3.4.59: VA Benefits that have special treatment – partially excluded
Excluded as income is that portion of a VA benefit (Pension or Compensation) which is paid to disabled veterans, their spouses, widows or parents as an Aid and Attendance, Housebound Allowance or payments resulting from Unusual Medical Expenses.
There are two exceptions to this rule:
Benefits in excess of $90.00 per month are counted in determining the cost of care for a resident of a State Veteran’s Nursing Home if the resident is a veteran with no dependents or surviving spouse with no dependents.
There is no exclusion of benefits when determining the cost of care in a RCF, CRBH, or AFC.
VA benefits for dependents. VA may increase the amount of a benefit if the veteran or surviving spouse has a dependent.
When the increase is included in the payment to the veteran or surviving spouse and the dependent resides with the veteran or surviving spouse. This is called an “augmented benefit." The share attributed to a dependent is income to the dependent only. If the dependent does not live with the veteran or surviving spouse, the dependent’s share is not income to anyone.
When the dependent of a veteran or surviving spouse does not live with the veteran or surviving spouse VA may pay the increase directly to the dependent. This is called an “apportionment” or
“apportioned benefit”. This payment is unearned income to the dependent.
Section 3.4.60: Vendor Payments – excluded:
Vendor payments (payments for goods or services provided to an eligible individual or couple which are made directly to a vendor by a third party).
Section 3.4.61: Volunteer Service Programs – excluded:
Any payment whether cash or in-kind made under the Domestic Volunteer Service Act Public Laws (93-113)
Title I - Corporation for National and Community Service (CNCS) (formerly ACTION):
AmeriCorps State and National, AmeriCorps NCCC, and AmeriCorps* VISTA,
University Year for Action (UYA), and
Special and Demonstration Volunteer Programs.
Title II - National Older American Volunteer Programs which now include:
Foster Grandparent Program
Senior Companion Program
(Retired Senior Volunteer Program (RSVP)
Title III - (repealed and now contained within the Small Business Act)
Service Corps of Retired Executives (SCORE)
Active Corps of Executives (ACE)
To become qualified to make presumptive eligibility determinations, a hospital must do the following:
1. Participate as a Medicaid provider under the State of Maine’s State Plan;
2. Notify the Office for Family Independence (OFI) in writing of its intention to make presumptive eligibility determinations under this Part;
3. Accept training, administered by OFI, for all applicable staff on relevant MaineCare eligibility rules and regulations;
4. Be certified by OFI and agree to make presumptive eligibility decisions according to state and federal policies; and
5. Not currently be disqualified from performing presumptive eligibility as result of failing to meet the performance requirements outlined in Section 8.
Hospital presumptive eligibility determinations must be limited to persons who meet all eligibility requirements for coverage under any one of the following eligibility groups:
1. Children (Part 3, Section 2.1),
2. Parent/Caretaker Relative (Part 3, Section 2.2),
3. Pregnant Women (Part 3, Section 2.3),
4. Expansion Adults (Part 3, Section 2.4),
5. Former Foster Care Children (Part 3, Section 3.1(C)),
6. Family Planning Coverage (Part 9, Section 4); or Coverage for women who are in treatment for breast and cervical cancer under Maine Title 10-144 C.M.R. Ch. 708.
A qualified hospital must use a Hospital Presumptive Eligibility application (HPE-App) provided by the Department to establish the applicant’s household size and income. Applications may be accessed at the Department’s website; or by contacting the MaineCare Eligibility Program Manager by mail, phone, or e-mail.
Hospitals are prohibited from requiring individuals to provide verification of any of the eligibility factors used in the Medicaid determination. Hospitals must accept the individual’s attestation for all factors of eligibility.
If the hospital determines the applicant meets all the eligibility requirements for coverage in one of the coverage groups listed in Section 2, the hospital shall determine that the applicant is presumptively eligible for MaineCare coverage.
Once a hospital determines an individual is presumptively eligible, Medicaid coverage begins on the date the hospital determines eligibility and continues until the later of the following:
1. If a full MaineCare application is filed prior to the last day of the month following the month presumptive eligibility was determined, the date on which a final eligibility decision is made; or
2. The last day of the month following the month in which presumptive eligibility was determined if no application for Medicaid has been filed by that date.
For pregnant women, one period of presumptive eligibility is allowed per pregnancy. Otherwise, applicants are only allowed one HPE period in a twelve-month period, starting with the effective date of the initial presumptive eligibility period.
It is the responsibility of the hospital to do the following:
1. Accept the individual’s attestation of all eligibility factors including income, citizenship status, immigration status, and State residency status. The hospital cannot require verification;
2. Provide presumptive eligibility applicants with a full MaineCare application, or as appropriate, an application for breast and cervical cancer treatment with the Maine CDC Breast and Cervical Health Program – and information about how to complete it;
3. Notify the presumptive eligibility applicant of the presumptive determination in writing (and orally if appropriate), at the time the determination is made; and
4. Take the following action based on whether the applicant was found eligible or ineligible:
A. For a presumptive eligibility applicant determined not presumptively eligible, notify the applicant in writing at the time of the determination (and orally if appropriate) of the reason for the denial and that the applicant may file an application for MaineCare with OFI; or
B. For a presumptive eligibility applicant determined to be eligible the hospital must:
(1) Complete a MaineCare Hospital Presumptive Eligibility Card (HPE-Card) for the individual;
(2) Notify OFI of each presumptive eligibility determination within five working days from the date the determination was made including submitting a copy of the HPE-Card;
(3) Provide a copy of the HPE-Card to the applicant; and
(4) notify the applicant (in writing and orally if appropriate) of the following:
(a) that if the applicant does not file a full MaineCare application with OFI, or an application for breast and cervical cancer treatment with the Maine CDC Breast and Cervical Health Program, before the last day of the following month, presumptive eligibility coverage will end on that last day; and
(b) that if the applicant files a full MaineCare application with OFI or an application for breast and cervical cancer treatment with the Maine CDC Breast and Cervical Health Program before the last day of the following month, presumptive eligibility coverage will continue until an eligibility determination is made on the application that was filed.
OFI is required to provide appropriate notices regarding eligibility decisions made on a full MaineCare application filed by or on behalf of the individual determined to be presumptively eligible. OFI is not required to send any notice regarding the discontinuance of the presumptive eligibility period and the individual has no rights of appeal in regard to that discontinuance.
Performance Standard
Qualified hospitals must maintain performance standards in order to continue performing presumptive eligibility determinations. In a rolling six-month period and based on a statistically significant sample of cases, no less than 80% of applicants granted presumptive eligibility by a hospital must file a regular MaineCare application with OFI before the last day of the month following the month of a presumptive eligibility determination.
Corrective Action
A. The first time OFI determines that a qualified hospital has failed to meet the Performance Standards established in Section 7(1), OFI will notify the hospital in writing within five business days from when OFI determined the hospital did not meet the standard. The written notice will include the following:
(1) A description of the standard that was not met and an explanation of how the determination was made; and
(2) A request for confirmation that all applicable hospital staff will participate in mandatory training on hospital presumptive eligibility rules and regulations. Such training will be conducted by OFI.
B. When OFI determines that a qualified hospital has failed to meet any of the Performance Standards established in Section 7(1) within 24 months of issuance of a written notice under Section 7(2)(A), OFI will notify the hospital in writing within five business days of determining the hospital did not meet the standard. The written notice will include the following:
(1) A description of the standard that was not met and an explanation of how the determination was made; and
(2) Confirmation that if the hospital fails to meet the standard established in Section 7(1) again within the subsequent 24-month period, the hospital will be disqualified from making presumptive eligibility determinations for a period of 12 months and until the hospital becomes requalified pursuant to Section 1.
STATUTORY AUTHORITY: 22 M.R.S. §§ 42(1); 3173
AMENDED:
April 29, 2025 – filing 2025-101
February 2, 2025 - filing 2025-025
October 22, 2014 - filing 2024-240
October 13, 2024 - filing 2024-232
August 18, 2024 – filing 2024-183
August 18, 2024 – filing 2024-185
August 18, 2024 – filing 2024-184
May 26, 2024 – filing 2024-127
February 2, 2024 – filing 2024-018
August 15, 2023 – filing 2023-123
June 5, 2023- filing 2023-077
November 6, 2022 – filing 2022-218
January 1, 2020 – filing 2020-138
May 10, 2021 – filing 2021-092
February 1, 2020 – filing 2020-174
July 1, 2020 – filing 2020-122
April 17, 2019 – filing 2019-063
July 1, 2017 – filing 2017-097
October 1, 2016 – filing 2016-153
August 1, 2016 – filing 2016-128
December 30, 2015 - filing 2015-257
December 23, 2015 - filing 2015-252
November 2, 2015 - filing 2015-204
July 1, 2014 - filing 2015 -041 (3/13/15)
February 18, 2015 – filing 2015-016
February 2015 – filing 2015-015
October 19, 2014 – filing 2014-259
June 1, 2014 – filing 2014-103
March 26, 2014 – filing 2014-050
January 1, 2014- filing 2013-330
December 18, 2013 – filing 2013-322
January 22, 2013 – filing 2013-010
August 1, 2010 – filing 2010-322
September 1, 2009 – 2009-438
October 2003 – filing 2003-359
January 8, 2003 – filing 2003-3
December 1, 1998 – filing 1998-512
July 1, 1998 – filing 1998-331
NON-SUBSTANTIVE CORRECTION (addition of header information in Part 16, as well as Part number and name at the beginning of Part 16): December 12, 2025
APAO ACCESSIBILITY CHECK: December 12, 2025 (no issues detected)
NONSUBSTANTIVE CORRECTIONS (terminology updates):
May 20, 2026
10-144
MAINE DEPARTMENT OF HEALTH AND HUMAN SERVICES
OFFICE FOR FAMILY INDEPENDENCE
SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM EMPLOYMENT AND TRAINING (SNAP E&T) RULES
SECTION 1: DEFINITIONS, AUTHORIZATION, and ADMINISTRATION 1
DEFINITIONS 1
AUTHORIZATION 3
ADMINISTRATION 3
SECTION 2: PARTICIPANT ELIGIBILITY AND PRIORITY TARGET GROUPS 4
I. PARTICIPANT ELIGIBILITY 4
II. PRIORITY TARGET GROUPS 4
SECTION 3: SNAP E&T REFERRAL PROCESS 5
I. REFERRAL PROCESS 5
II. VOLUNTARY PARTICIPATION 5
III. APPOINTMENT SCHEDULING 5
ORIENTATION, ASSESSMENT and INDIVIDUALIZED EMPLOYMENT PLAN (IEP) 5
SECTION 4: EMPLOYMENT AND TRAINING SERVICE COMPONENTS 7
NON-WORK COMPONENTS 7
WORK COMPONENTS 8
EDUCATIONAL COMPONENTS 9
SECTION 5: COMPLETION and DISCHARGE FROM SNAP E&T 10
COMPLETION 10
DISCHARGE 10
SECTION 6: SNAP E&T SERVICES FOR ABAWDS 11
SECTION 7:PROVIDER DETERMINATION 12
I. PROVIDER DETERMINATION 12
II. DEPARTMENT RESPONSIBILITIES 12
SECTION 8: PARTICIPANT REIMBURSEMENT SERVICES 14
PARTICIPANT REIMBURSEMENT SERVICE LIMITS 14
ALLOWABLE TRANSPORTATION RELATED EXPENSES 16
DEPENDENT CARE REIMBURSEMENT 17
SECTION 9: PARTICIPANT RIGHTS AND RESPONSIBILITIES 18
SECTION 10: DISQUALIFICATIONS 19
DISQUALIFICATION OF VOLUNTARY PARTICIPANTS 19
GOOD CAUSE 19
SECTION 11: CONCILIATION AND ADMINISTRATIVE HEARINGS 20
CONCILIATION 20
ADMINISTRATIVE HEARINGS 20
SECTION 12: CONFIDENTIALITY 22
authority and revision history 23
SUMMARY: This rule describes the Supplemental Nutrition Assistance Program Employment and Training (SNAP E&T) Program, which provides employment and training services for Federal SNAP Recipients. The goal of SNAP E&T is to assist Participants in obtaining sustainable employment that reduces or eliminates dependency on SNAP benefits. The rules prescribe program authorization, goals, administration, Participant eligibility, services and support services, and operating procedures and standards for SNAP E&T Providers.
SECTION 1: DEFINITIONS, AUTHORIZATION, and ADMINISTRATION
DEFINITIONS
Able-bodied Adult without Dependent (ABAWD) - a Recipient as defined in 10-144 C.M.R. Ch. 301 Supplemental Nutrition Assistance Program (SNAP) Rules Manual, Section 111-7.
Assessment - An individualized process designed to integrate the array of SNAP E&T services with educational and vocational needs, including review of employment and educational history, interests and abilities of each Participant, barriers to employment, and support service needs to develop an Individualized Employment Plan as an interactive process between the Participant and the SNAP E&T Provider.
Basic Skills Education - educational or basic skills training such as Adult Basic Education (ABE), basic literacy, English as a Second Language (ESL), high school equivalency (HiSET), and other remedial courses necessary for job attainment and/or prerequisites or necessary for participating in post-secondary education consistent with 7 C.F.R. §273.7(e)(2)(vi)(A).
Case Management - As outlined in 7 C.F.R. §273.7(e)(1), Case Management is the ongoing process of interactive communication, identifying the needs of the Participant, coordinating services appropriate to meet those needs, and monitoring and supporting the Participant’s progress through SNAP E&T so that the Participant can gain the skills and support to obtain employment. Case management must be provided by all SNAP E&T Providers in addition to at least one SNAP E&T service component.
Component - Educational, training, or employment activities approved by SNAP E&T and delivered to meet federally defined standards for SNAP Employment and Training programs in 7 C.F.R. §273.7(e)(2). SNAP E&T services may include Non-work, Work, and Educational Components. SNAP E&T Providers are not required to deliver all service components.
Educational Component - is a SNAP E&T component as defined in 7 C.F.R. §273.7(e)(2) that includes basic skills education, vocational, or post-secondary undergraduate education for specific high skilled jobs. Educational Components may be counted as a qualifying ABAWD Work Component when the ABAWD is enrolled at least 20 hours per week or half-time in an Educational Component, as determined by the educational institution.
Fair Hearing (also known as an Administrative Hearing) - A hearing conducted before a Department of Health and Human Services hearings officer in which a Participant has an opportunity to dispute a decision made by the Department. The hearing officer’s decision is binding on all parties and is subject to possible Superior Court review.
Food and Nutrition Services (FNS) - The division of the United States Department of Agriculture (USDA) that works to end hunger and obesity through the administration of federal nutrition assistance programs including Supplemental Nutrition Assistance Program (SNAP), and school meals in partnership with State and Tribal governments.
Individualized Employment Plan (IEP) - An agreement between the SNAP E&T Provider and the Participant, which outlines the responsibilities of each party, including services to be provided by SNAP E&T, and actions to be taken by the Participant to achieve a short or long-term employment related goal identified in the IEP.
Job Retention - A SNAP E&T component as defined in 7 C.F.R. §273.7(e)(2)(viii) that provides case management and Participant Reimbursements and other SNAP E&T services to Participants who obtain a job through their SNAP E&T enrollment.
Non-work Component - includes federally defined Job Search, Job Search Training, and Job Retention Component services as defined in 7 C.F.R. §273.7(e)(2) typically used to help a Participant achieve job readiness or retain employment attained through SNAP E&T participation.
Participant - a federal SNAP Recipient who is enrolled in SNAP E&T services.
Participant Reimbursement - Reimbursements pursuant to 7 C.F.R. § 273.7(d)(4) for services or items such as transportation, childcare, books, tools, equipment or work clothing that are necessary for the Participant to complete the SNAP E&T component in which they are enrolled and have identified in their IEP. Participant Reimbursement costs can only be reimbursed by the Department directly to the SNAP E&T Provider or Participant.
Provider (SNAP E&T Provider) - either the Department or a contracted vendor that provides SNAP E&T services.
Provider Determination - is when the SNAP E&T Provider determines the individual is not a good fit for the SNAP E&T component in which the individual is participating pursuant to 7 C.F.R. § 273.7(c)(18). SNAP E&T Providers have the authority and responsibility to make this determination based on assessment and participation and notify the Department so that the Participant can be notified and other SNAP E&T options explored.
Qualifying Component - an Educational or Work Component pursuant to 7 C.F.R. § 273.7(e)(2) that may be used toward ABAWD work requirements.
Recipient - an eligible individual included in a SNAP household and currently receiving or enrolled for SNAP benefits.
Work Component - an employment and training service component as defined in 7 C.F.R. § 273.7(e)(2) that qualifies for federally defined standards to meet ABAWD work requirements. Work Components include apprenticeships, Job Retention, workfare, and work experience.
Work Registrant - a Recipient between the ages of 16-59 who is subject to the federal work requirements identified in 7 C.F.R. § 273.7(a)(1)(i-vii).
II. AUTHORIZATION
The Maine Department of Health and Human Services, Office for Family Independence, is authorized to operate the SNAP Employment and Training (SNAP E&T) program for SNAP Recipients under provisions of the federal Food Stamp Act of 1977 (P.L. 93-133, Section 17), as amended, which is contained in Title 7 United States Code §2015(d)(4). It is authorized under Maine Law at 22 M.R.S. § 3104. It is governed by regulations promulgated by the U.S. Department of Agriculture, Food and Nutrition Service, as set forth at 7 C.F.R. § 273.7.
III. ADMINISTRATION
USDA FNS - The U.S. Department of Agriculture (USDA), Food and Nutrition Service (FNS), is the federal government body that has regulatory oversight, provides the federal portion of funding, and approves annual program plans for the Supplemental Nutrition Assistance Program Employment and Training (SNAP E&T) program.
DHHS/OFI - The Department of Health and Human Services (DHHS) is the state agency designated by the USDA/FNS for the administration of SNAP and SNAP E&T. Within DHHS, the program is administered by the Office for Family Independence (OFI). OFI may provide SNAP E&T services or may contract with SNAP E&T Providers to administer SNAP E&T services subject to the requirements in this rule.
SERVICE AREA - SNAP E&T services may have limited availability throughout the state, depending on where the Department has SNAP E&T Providers available to deliver services.
FUNDING - Services are limited to the extent that program funding and resources permit.
SECTION 2: PARTICIPANT ELIGIBILITY AND PRIORITY TARGET GROUPS
PARTICIPANT ELIGIBILITY
To be eligible for SNAP E&T services, Recipients must:
be receiving or enrolled for federal SNAP benefits in the State of Maine and be included in the federal SNAP household;
not receiving TANF benefits;
be aged 16 or older;
able to work in the field for which they are training, and
be residing within a one-hour one-way drive (60 miles) or commute to the location of SNAP E&T services or training to be provided, if such services require onsite participation.
Eligibility is also based on availability of funds and availability of SNAP E&T Providers in the area where the Recipient resides.
PRIORITY TARGET GROUPS
Because funding for SNAP E&T services is limited based on FNS approval of an annual plan and availability of federal funding, SNAP E&T Providers must enroll Participants based on the following priorities:
A. The first priority for SNAP E&T is to provide employment and training services to SNAP Recipients who are subject to federal work requirements set forth in 7 C.F.R. § 273.7, including mandatory work registrants, also as outlined in Sections 111-5 and 111-6 of Supplemental Nutrition Assistance Program (SNAP) Rules, 10-144 C.M.R. Chapter 301, and able-bodied adults without dependents (ABAWDS), as defined in 7 C.F.R. § 273.24 and in Section 111-7 of Supplemental Nutrition Assistance Program (SNAP) Rules, 10-144 C.M.R. Chapter 301.
B. If funding is available, SNAP E&T Providers may enroll SNAP Recipients who are otherwise eligible for SNAP E&T but currently exempted from work requirements in employment and training services, so long as the Participant’s goal is to obtain a job, and the assessment conducted by the SNAP E&T Provider and identified in the Individualized Employment Plan determines that employment can be realistically obtained within one year of starting services or upon completion of the employment and training program.
SECTION 3: SNAP E&T REFERRAL PROCESS
REFERRAL PROCESS
SNAP Recipients may be recruited by the SNAP E&T Provider or be referred to the SNAP E&T Provider by the Department or other community agencies. SNAP E&T Providers must determine that the Recipient is currently receiving or enrolled for SNAP benefits and eligible to participate prior to enrolling a Participant.
SNAP Recipientss may also be referred to Provider agencies by the Department.
Enrollment in SNAP E&T is determined by the Department upon review of eligibility and assessment information gathered by Providers. The Department makes final determination of eligibility.
VOLUNTARY PARTICIPATION
Eligible SNAP Recipients may voluntarily participate in SNAP E&T services where available. All SNAP E&T services are voluntary. A decision to not participate or to disenroll has no impact on continued receipt of SNAP benefits.
APPOINTMENT SCHEDULING
Participants are expected to keep all appointments scheduled by SNAP E&T Providers unless there is Good Cause for absence. Participants may be discharged from SNAP E&T by the SNAP E&T Provider if they fail to keep appointments or participate in SNAP E&T activities identified in their IEP.
ORIENTATION, ASSESSMENT and INDIVIDUALIZED EMPLOYMENT PLAN (IEP)
ORIENTATION
SNAP E&T Participants must be informed by the SNAP E&T Provider what services and Participant Reimbursements they may be eligible for and must sign a Participation Agreement that outlines SNAP E&T services and program rules and their rights and responsibilities. Participants must also sign an Authorization to Release Information Form allowing the Department and SNAP E&T Providers to share ongoing information necessary for SNAP E&T participation.
ASSESSMENT
SNAP E&T Participants and Providers must review the Participant's education and employment history, employment and training interests, barriers to employment, and Participant Reimbursement needs (e.g., dependent care and transportation) as part of the assessment process.
C. INDIVIDUALIZED EMPLOYMENT PLAN (IEP)
SNAP E&T Providers complete an Individualized Employment Plan (IEP) with the Participant based upon information obtained during the assessment to determine what services and Participant Reimbursements will be provided. The IEP is developed for the time period necessary to accomplish steps to attain the goals of the IEP. The IEP must be amended when there is a change in circumstances affecting progress, or there is a change in goals or services. The IEP lists the training and employment related activities in which the Participant will engage, as well as performance expectations. The IEP, also, identifies Participant Reimbursements necessary to assist in completing training goals. The IEP is updated and amended as necessary, and at a minimum, updated every six months.
SECTION 4: EMPLOYMENT AND TRAINING SERVICE COMPONENTS
Employment and training service components are defined in 7 C.F.R. § 273.7(e)(2) and may be limited in availability to the extent that SNAP E&T Providers deliver specific service components in specific geographic locations.
SNAP E&T services that may be delivered are categorized as Non-work Components, Work Components, and Educational Components. All SNAP E&T Providers are required to provide case management services to SNAP E&T Participants during their SNAP E&T participation, which requires at a minimum monthly contact with SNAP E&T Participants to track and coach progress related to SNAP E&T participation. SNAP E&T Participants may be co-enrolled with more than one SNAP E&T Provider only when the providers are delivering separate components of services as listed below to the Participant. (E.g. a Participant may have their case management and Job Search Training Component reimbursed by one provider and their Educational Component by another.) SNAP E&T Participants may not receive the same component of service from more than one SNAP E&T Provider in the same month, and in the event that more than one Provider offers that component of service, the Participant may select the Provider of their choice.
The following employment and training service components may be delivered:
I. NON-WORK COMPONENTS
A. Job Search Training
Job Search Training is a component that assists Participants to become job ready by teaching job seeking techniques and working with Participants to increase their self-confidence and job search motivation. The component may include job skills assessments beyond the initial assessment, job clubs, and other employment related training. Job Search Training may also have specific activities to assist Participants who have not recently been in the workforce or are from a different culture. Necessary Job Search Training services are identified on an individual basis and may also include but are not limited to interview workshops, resume writing, Maine JobLink registration to apply for jobs online, and job searching activities. Depending on needs, some Participants may receive more intensive services to help them become work ready, including time management, budgeting, or assistance with transportation.
B. Job Search
Job Search is the component that requires job ready Participants to contact a minimum of three employers per week regarding potential employment and keep a job search log. Job Search must be a supervised activity in order to meet federal requirements outlined in 7 C.F.R. § 273.7 (e)(2).
The component allows the Participant to conduct job searches independently or within a group setting, and includes case management from the SNAP E&T Provider to support Job Search activities.
C. Job Retention
Job Retention services pursuant to 7 C.F.R. § 273.7(e)(2)(viii) provide case management and Participant Reimbursements for Recipients who have obtained a job through working with the SNAP E&T Provider. Job Retention services can typically be provided for a minimum of 30 days up to 90 days after starting a job that was obtained through participation in SNAP E&T. Maine received approval from FNS on August 13, 2020 to expand the duration of Job Retention services to a maximum of 365 days effective October 1, 2020 through September 30, 2024. The Department received renewal approval for the Job Retention waiver from October 1, 2024, through September 30, 2029. This component allows case management services and some Participant Reimbursements for equipment, tools, uniforms, childcare, relocation assistance, and transportation to support the participant in retaining a job.
ABAWDs are limited to a maximum of two hours per week of Job Retention services that can be counted toward ABAWD work requirements, which may be combined with 18 hours of ABAWD work requirements.
Job Retention is the only SNAP E&T component that may be delivered to Participants who lose their SNAP eligibility due to excess income when they attain employment through SNAP E&T participation.
II. WORK COMPONENTS
A. Workfare
Workfare is a component in which SNAP Recipients defined as ABAWDs are required to work off the value of their household’s monthly SNAP allotment through assignment at a private or public non-profit agency as a condition of eligibility. The goal is to improve employability and encourage Recipients to move into regular employment. This can be completed by more than one household member to reach the total required hours.
B. Work Experience
Work Experience includes on-the-job training, job-specific training, apprenticeships, pre-apprenticeships, or “earn while you learn” opportunities in a classroom or with an employer. The employer may be not-for-profit, private or for-profit. This component has the primary goal of developing specific work skills and employability of Recipients.
III. EDUCATIONAL COMPONENTS
A. Basic Skills Education
Basic Skills Education as defined above may only be reimbursed for classes or services that are not otherwise available to the Participant at no cost. SNAP E&T Participants enrolled in Basic Skills Education through the SNAP E&T Provider may be eligible to receive Participant Reimbursements for services necessary to complete the Basic Skills Component even when that course is funded by another source, e.g., high school equivalency (HiSET) courses available at no cost to residents of a particular municipality. Basic Skills may include but are not limited to high school diploma or equivalency, English as a Second Language, math or reading to assist a Participant in becoming eligible for post-secondary education, or other classes or programming necessary to assist with a vocational goal.
B. Post-Secondary
The SNAP E&T Post-secondary Education component can reimburse post-secondary educational activities such as short-term vocational training, certification programs, and two-year and four-year undergraduate degrees in programs that have direct links to employment. SNAP E&T requires that Providers use the most economic and efficient services, encouraging Maine Community Colleges and University of Maine system programs over private for-profit institutions. Direct links to employment are determined by the State of Maine Department of Labor and are occupations defined as high-compensation occupations with demand for skilled labor as per the criteria outlined in 12-597 C.M.R. Ch. 2, and included in the Competitive Skills Scholarship Program (CSSP) Approved Occupations List at https://www.myworksourcemaine.gov/pages/competitive-skills-scholarship-program-cssp
SNAP E&T cannot reimburse tuition for students who have failed to maintain satisfactory progress (Grade Point Average falling below 2.0), are on academic probation at the institution in which they are enrolled, or have been discharged from other tuition assistance programs such as CSSP or Higher Opportunity for Pathways to Employment (HOPE) due to failure to maintain satisfactory academic progress.
SNAP E&T completion and discharge dates are recorded by SNAP E&T Providers and reported to the Department for purposes of reimbursement, benefit status determination, and for performance measurement.
I. COMPLETION
A Participant has completed participation in SNAP E&T when:
A. the Participant obtains suitable full-time employment (at least 30 hours per week or when weekly earnings exceed the Federal minimum wage multiplied by 30) and no further services are planned.
B. the Participant completes the component or indicates that SNAP E&T services are no longer needed;
C. pursuant to 7 C.F.R. § 271.2, the SNAP E&T Participant has not received any SNAP E&T services for at least 90 days and no future services are planned.
II. DISCHARGE
SNAP E&T Providers cannot be reimbursed for services provided to Participants who lose SNAP eligibility during a training program, and may discharge them from SNAP E&T when they lose their SNAP eligibility. SNAP E&T Providers may continue to serve Participants enrolled in a Job Retention Component who lose financial eligibility, since federal guidelines in 7 C.F.R. § 273.7(e)(2) allow continued reimbursement for Participants enrolled in a Job Retention Component, meeting the Department’s time limits for Job Retention. The SNAP E&T Provider must discharge the Participant when:
A. the Provider cannot contact the Participant for two consecutive months; or
B. the Participant does not or cannot complete any planned SNAP E&T activities for two consecutive months; or
C. Provider Determination is made that the Participant is no longer an appropriate fit for the SNAP E&T Program (See Section 7); or
D. the Participant requests to withdraw or be discharged from the SNAP E&T Program.
Participants who have been discharged may re-enroll should they become able to participate again, be determined as a good fit by the SNAP E&T Provider, and are approved by the Department.
SECTION 6: SNAP E&T SERVICES FOR ABAWDS
ABAWDs are subject to all requirements outlined in Section 111-7 of the Supplemental Nutrition Assistance (SNAP) Rules, 10-144 C.M.R. Chapter 301.
ABAWDs may meet some or all of their work requirements by participating in a qualifying component of a SNAP E&T program delivered by a SNAP E&T Provider. Not all SNAP E&T services can be counted towards fully meeting ABAWD work requirements. To fully meet ABAWD work requirements through SNAP E&T participation, an ABAWD must be participating in SNAP E&T programming that includes a federally defined qualifying Work Component with participation of at least 20 hours per week or be enrolled in an approved Educational Component at least half time, as defined by the education institution. Non-work Component activities including Job Search, Job Search Training, and Job Retention may only count actual hours of participation up to 9.75 hours per week towards ABAWD work requirements, with qualifying SNAP E&T Work Components or paid employment making up the remainder of the 20 hours per week ABAWD work requirement.
SECTION 7: PROVIDER DETERMINATION
I. PROVIDER DETERMINATION
A. Participants who do not adhere to SNAP E&T Provider performance requirements may be discharged from SNAP E&T services by the Provider and/or discharged from SNAP E&T by the Department. Requirements are part of the IEP. Participants may request conciliation or administrative hearings, as detailed in Section 11.
(1) SNAP E&T providers are required to determine if an individual is ill-suited for a particular SNAP E&T component. This process is called Provider Determination. The SNAP E&T provider shall notify the Department of a Provider Determination within 10 days of the date the determination is made and inform the Department of the reason for the Provider Determination.
(2) If a SNAP E&T provider finds an individual is ill-suited for one component, but the SNAP E&T provider determines the individual may be suitable for another component offered by the SNAP E&T provider, at Department option, the SNAP E&T provider may switch the individual to the other component and inform the Department of the new component without the need for the Department to act further on the Provider Determination.
II. DEPARTMENT RESPONSIBILITIES
Pursuant to 7 C.F.R. § 273.7(c)(18), when the Department receives notification that an individual has received a Provider Determination, the Department shall:
A. Notify the SNAP E&T Participant, within 10 days of receiving notification from the SNAP E&T provider, of the Provider Determination including the following information, as applicable.
The Department shall explain—
what a Provider Determination is,
the next steps the Department will take as a result of the Provider Determination, and
c. contact information for the Department.
(2) The Department shall also notify the individual that they are not being sanctioned as a result of the Provider Determination.
(3) In the case of an ABAWD who has received a Provider Determination, the Department shall also notify the ABAWD that the ABAWD will accrue countable months toward their three-month participation time limit the next full benefit month after the month during which the Department notifies the ABAWD of the Provider Determination, unless—
a. the ABAWD fulfills the work requirements in accordance with 7 C.F.R. § 273.24, or
b. the ABAWD has good cause, lives in a waived area, or is otherwise exempt.
(4) The Department may make such notification either verbally or in writing, but shall, at a minimum, document when the notification occurs in the Participant's case file;
and
B. Take the most suitable action from among the following options no later than the date of the individual's recertification. If an individual with a Provider Determination requests that the Department take one of the following actions sooner than the next recertification, the Department shall take the most suitable action as soon as possible:
(1) Refer the individual to an appropriate SNAP E&T program component if available;
(2) Refer the individual to an appropriate workforce partnership if available;
(3) Reassess the physical and mental fitness of the individual for exemption from work requirements; or
(4) Coordinate, to the maximum extent practicable, with other Federal, State, or local workforce or assistance programs to identify work opportunities or assistance for the individual.
SECTION 8: PARTICIPANT REIMBURSEMENT SERVICES
A Participant may be eligible for reimbursement of training and job-related expenses called Participant Reimbursements, pursuant to 7 C.F.R. § 273.7(d)(4) that are determined necessary for SNAP E&T participation, incurred directly as a result of SNAP E&T participation, and identified in the IEP. Reimbursement may include mileage reimbursement, books, education fees, occupational clothing and equipment, dependent care and other needs preapproved by the Department as being legitimate costs of participation and included in the IEP. Any Participant Reimbursement for which SNAP E&T will make payment must be the least expensive quality alternative available that will not cause delay or hinder progress of the IEP.
SNAP E&T Providers may acquire necessary items or reimburse Participants for these expenses and are required to inform Participants of Participant Reimbursement services that may be reimbursable. All Participant Reimbursements exceeding $25 must be approved by the Department prior to purchase or delivery, and the approved costs can only be reimbursed directly to the SNAP E&T Provider or Participant.
Because Participant Reimbursements must be issued prior to some SNAP E&T activities, to remove barriers to participation (such as access to transportation), the Provider may issue gift cards, such as gas cards, when necessary and no other method is viable for this purpose. When gift cards are issued to meet Participant Reimbursement requirements, the Provider must have policy and procedures in place that meet the DHHS Gift Card Checklist that is attached to their contract and have those policies and procedures approved and signed by the Provider and DHHS. Providers must follow their approved policies and procedures which includes abiding by all prior authorizations and Participant Reimbursement caps in their contract in issuing gift cards for the purpose of Participant Reimbursements.
A SNAP E&T Participant becomes eligible for Participant Reimbursements on the date of active enrollment in an approved SNAP E&T component, and for each month that the Participant remains actively enrolled in the SNAP program and a SNAP E&T component.
Participant Reimbursements are subject to both federal and state approval and Provider funding availability and are issued at the Provider’s financial risk should the Participant Reimbursement not be allowable. All Participant Reimbursements must be directly linked to the IEP and identified in the IEP and progress notes.
I. SUPPORT SERVICE LIMITS:
The following limits or caps apply to all SNAP E&T Participants and are subject to Department pre-approval which must be obtained by the SNAP E&T Provider and is subject to allowability of federal and Provider funding:
Support Service Item | Maximum Amount Reimbursed Per Participant per federal fiscal year (October 1-September 30). Tuition | $ 10,000 for full-time students and $ 5,000 for part-time students , limited to certificate or undergraduate degrees. All other financial aid, grants, and scholarships must be exhausted. When SNAP E&T is the primary payor, Prior Authorization is required using the Department approved form at: https://www.maine.gov/dhhs/ofi/programs-services/food-supplement/fset/information-for-providers . The Provider must demonstrate that the institution of choice is the most economic and efficient selection for the course(s) or program the Participant wants to enroll in and that the program leads to a career that is high wage and in demand, as determined by the Maine Department of Labor website listed at: https://www.myworksourcemaine.gov/pages/competitive-skills-scholarship-program-cssp Participant Reimbursement Caps Transportation | Mileage, bus passes, taxi fares , or gas cards. Transportation reimbursement is limited to $ 140 per week , unless otherwise approved by the Department. Mileage is reimbursed consistent with current State of Maine mileage rate for actual mileage or calculation of gas card denominations. The State of Maine rate is found on the Department of Administrative and Financial Services Office of the State Controller at https://www.maine.gov/osc/travel/mileage-other-info The State of Maine rate is the amount to be used if the standard mileage allowance is claimed. Automobile repairs are limited to $1, 500 per federal fiscal year (FFY) and subject to additional requirements under Section II below. The most economic mode of transportation must be utilized. Eye care (not otherwise covered) | $ 300 Dental Care (not otherwise covered) | $500 Books and Supplies including laptops (as approved for specific Educational Component programming) | $2,000 Tools and equipment, work clothing and footwear | $1,000 per FFY year Other Supports | Other supports are reimbursed only when approved by the Department and are directly related to the IEP and necessary to continue SNAP E&T programming. Internet or hotspots are limited to $50 per month, and are only covered if not already counted as a Standard Utility Allowance budget expense for SNAP benefit calculations. For internet services reimbursement, a bill showing service address must be provided. One-time emergency rental assistance can only be reimbursed for currently enrolled SNAP E&T Participants who otherwise will be unhoused, and when it is the only option to continue SNAP E&T programming without disruption. Rent is limited to two months’ rent or one month rent plus one month security deposit, not to exceed Fair Market Rent set by HUD and published by Maine State Housing Authority at: https://www.mainehousing.org/charts/rent-income-charts .
Participant Reimbursements and tuition cannot be reimbursed for Participants who are receiving TANF cash benefits.
The Participants must sign a Contractor Reimbursement Form distributed by the SNAP E&T Provider acknowledging receipt of Participant Reimbursements in order to be reimbursed.
II. ALLOWABLE TRANSPORTATION RELATED EXPENSES
If a private vehicle is used by the Participant, reimbursement is made by the SNAP E&T Provider at the current rate per mile paid by the SNAP E&T program for the most direct route (including stops at a childcare provider) to and from the SNAP E&T service component site. A private vehicle must be properly registered and insured, and the driver must be legally licensed in order to receive reimbursement.
In areas where available and more economical, SNAP E&T Providers may purchase a gas card, bus pass or arrange payment for other public transportation on behalf of the SNAP E&T Participant in lieu of reimbursing for mileage. When gas cards are used, the denomination must be calculated according to mileage incurred by the Participant for approved SNAP E&T activities.
Vehicle repairs are subject to the limits above and are limited to vehicles that are registered and insured to the SNAP E&T Participant or legal spouse, who must have a valid driver’s license. Repairs can only be reimbursed for vehicles that will pass State safety inspection upon completion of the repair and will result in safe and reliable transportation to be used for the Participant’s training or employment. SNAP E&T Providers must submit a completed Department approved Vehicle Repair Form and obtain prior approval from the Department in order to reimburse vehicle repairs on behalf of SNAP E&T Participants. Vehicle repairs must be completed by an automobile repair shop authorized to conduct State safety inspections. The Department may require quotes from other automobile repair shops prior to approving a repair.
All transportation reimbursement is subject to the limits in the table above.
III. DEPENDENT CARE REIMBURSEMENT
A Participant who has dependents who require care during the hours the Participant is actively engaged in a component activity is eligible for the actual costs or the current limits established by the Maine Child Care Affordability Program, whichever is less, per dependent per month to cover dependent care costs. These rates are found at: https://www.maine.gov/dhhs/ocfs/support-for-families/child-care/paying-for-child-care. If the dependent is a child under age 13, and the childcare is not provided by a licensed or registered facility, the childcare arrangement must be approved prior to payment by the SNAP E&T Provider. SNAP E&T Providers must conduct a check of the childcare provider for present or prior child protective services involvement, checks with the State Bureau of Identification and Department of Motor Vehicles, and other approval procedures (such as a home visit) as may be deemed necessary on a case-by-case basis before reimbursing childcare providers. A childcare provider who is caring for more than two children who are unrelated to the childcare provider must be licensed or registered prior to being paid by the SNAP E&T Provider.
SECTION 9: PARTICIPANT RIGHTS AND RESPONSIBILITIES
Participants have certain rights and responsibilities in relation to the SNAP E&T program. Rights include being made aware of what services the SNAP E&T program offers, Good Cause, the availability of conciliation and administrative hearings, and disqualifications that may be applied for failure to comply with SNAP E&T rules or federal work registration requirements in 7 C.F.R. § 273.7. Responsibilities include following the rules of the program with regard to participation, keeping appointments and abiding by provisions of the IEP.
Participants are advised orally and in writing of their rights and responsibilities by the SNAP E&T Provider at the time of enrollment.
SECTION 10: DISQUALIFICATIONS
DISQUALIFICATION OF VOLUNTARY PARTICIPANTS
Voluntary participants may be disqualified from SNAP E&T in accordance with this section, but do not lose other SNAP benefits. SNAP E&T services are denied for the disqualification period when a voluntary participant is disqualified.
II. GOOD CAUSE
Disqualifying acts are excused if Good Cause exists. Good Cause reasons include those listed below:
Illness or incapacitation of the participant or a family member, which requires the presence of the participant. Verification by a physician may be required.
Sexual harassment occurring while a participant is engaged in SNAP E&T activities.
Court required appearance or incarceration.
Lack, or breakdown, of necessary support services such as childcare or transportation with no alternative available at no additional cost to the participant.
Inclement weather which is serious enough to prevent other participants from traveling to the activity.
Assignment of a participant to an activity which has not been made part of the IEP (other than orientation or assessment which predate development), or which is in violation of SNAP E&T rules.
Assignment to an activity, which requires the participant to relocate outside the immediate geographical area (an area within a one hour one way commute), unless the participant has voluntarily elected to relocate.
Inability to participate due to domestic violence. When the person is unable to participate due to physical injuries or psychological effects of abuse; because of legal proceedings counseling or other activities related to abuse; because the abuser actively interferes with the individual's participation; because the location puts the individual at risk; or for other Good Cause related to domestic violence.
Other circumstances beyond the control of the participant or that a reasonable person would consider to be Good Cause. It is the responsibility of the participant to demonstrate that Good Cause exists and to provide documentation or other proof of Good Cause when requested. Failure to do so to the satisfaction of the Department results in disqualification.
SECTION 11: CONCILIATION AND ADMINISTRATIVE HEARINGS
CONCILIATION
Conciliation meetings are informal meetings which are designed to resolve program related disputes between SNAP E&T Providers and the participant, without going to administrative hearing.
The following conditions apply to conciliation:
The SNAP E&T Provider shall attempt to establish conciliation prior to issuing a notice of non-compliance in instances where it is reasonable to believe that issues may be resolved. A SNAP E&T request for conciliation is made in writing within the ten calendar days of the date of an adverse action or an action, which is known to be in dispute. The participant may also initiate conciliation in instances where an action by the SNAP E&T Provider is disputed, although non-compliance may or may not be at issue. The participant must make the request orally or in writing within ten calendar days of the date the disputed action was received or acknowledged by the participant. If the participant's request is timely, the disputed action will not take effect pending completion of conciliation. Non-disputed actions must still take effect.
The conciliation process must not exceed 30 calendar days from the first meeting. If agreement has not been reached at the end of this period, the disputed decision remains in force unless overturned by administrative hearing.
The participant or the SNAP E&T Provider may terminate conciliation at any time the parties believe it is unproductive. If any party terminates conciliation, the action remains in force unless overturned by administrative hearing.
The participant may request an administrative hearing in addition to or instead of conciliation, providing the request is in accordance with time limits set forth for administrative hearings. If a timely request for conciliation is made, an administrative hearing request may be made within 90 days of the conciliation decision.
Any changes resulting from conciliation will be placed on the IEP. If there is no change, original actions remain in force unless overturned by administrative hearing.
The participant may have the same representation and access to records as allowed for administrative hearings.
ADMINISTRATIVE HEARINGS
A. RIGHT TO A HEARING
The participant has the right to request an administrative hearing, in accordance with 7 C.F.R § 273.15, to appeal a denial, reduction, or termination of benefits due to a determination of nonexempt status, or a Department determination of failure to comply with SNAP work
requirements. Participants may appeal Department actions such as exemption status, the type of requirement imposed, or Department refusal to make a finding of Good Cause if the Participant believes that a finding of failure to comply has resulted from improper decisions on these matters.
Any request for an administrative hearing must be made within ninety days of the date of the action or Department determination. The Department may waive time limits. Requests for hearings may be made orally or through emails. Hearing decisions are binding and when appropriate, will be made part of the IEP.
A participant may not be granted an administrative hearing if a reduction in services or benefits is a result of an overall reduction in program funding which affects all participants, unless the participant can demonstrate that there has been inequitable treatment in comparison to other similarly situated participants.
B. RULES GOVERNING HEARINGS
Administrative hearings are conducted by the Department's Division of Administrative Hearings in accordance with the Administrative Hearings Manual, and in accordance with the Supplemental Nutrition Assistance Program (SNAP) Rules, 10-144 C.M.R. Ch. 301, Section 777-1.
SECTION 12: CONFIDENTIALITY
The confidentiality of SNAP E&T participants is protected by the Maine Department of Health and Human Services, and provisions outlining confidentiality are at: https://www.maine.gov/dhhs/privacy/ and Supplemental Nutrition Assistance Program (SNAP) Rules, 10-144 C.M.R. Chapter 301, Section I. SNAP E&T Providers are contractually required to protect the confidentiality of SNAP E&T participants.
Release of information about a SNAP E&T participant (including to other Offices and Divisions within the Department of Health and Human Services and to SNAP E&T Providers under contract with the Department to provide services to SNAP E&T participants, or other agencies providing services) are made only when such release is directly related to that individual's participation in SNAP E&T and necessary to determine eligibility for benefits or services provided by the Department or other agencies.
Release of information to entities other than those described above are made only upon receipt of written permission from the participant using the Department’s Authorization to Release Form available at: https://www.maine.gov/dhhs/privacy/authorization-release.pdf.
STATUTORY AUTHORITY:
22 M.R.S. §§ 42(1) and 3104; 7 C.F.R. § 273.7
EFFECTIVE DATE:
October 7, 1991
AMENDED:
August 15, 1992 - Section 18
EFFECTIVE DATE (ELECTRONIC CONVERSION):
May 5, 1996
AMENDED:
June 30, 1997 - Section 18 (D, E, H)
REPEALED AND REPLACED:
August 1, 2001
AMENDED:
March 1, 2007 – filing 2007-178
CORRECTED:
December 14, 2011 – agency names and program titles corrected
AMENDED:
April 1, 2015 – filing 2015-042 – various amendments, chapter renamed to “Food Supplement – Employment and Training (FSET) Program Rules”
REPEALED AND REPLACED:
October 1, 2020 – filing 2020-200
AMENDED:
May 1, 2021 – filing 2021-086 – Sections 1, 4, and 8 - Bachelor’s programs and co-enrollment approved, OJT supported
AMENDED:
August 6, 2023 – filing 2023-093 – References to “Food Supplement” updated to “SNAP”, Clarification added to Job Retention, Participant Reimbursements, SNAP Recipients, Participant Eligibility, Work Components, and Enrollment
AMENDED:
May 14, 2024 – filing 2024-118 – Mileage Reimbursement and Gift Card Policy Update
AMENDED:
July 01, 2025 – filing 2025-138 - Provider Determination
AMENDED:
July 8, 2025 (by APA Office, to include text that was proposed but inadvertently omitted during the process of preparing the rule for adoption).
ACCESSIBILITY CHECK: July 8, 2025
AMENDED:
August 30, 2026 – filing 2026-191