Maine Medicaid Office

Maine Medicaid offices (OMS + OFI)

MaineCare's administrative structure splits work across two DHHS offices, and members have to know which one to call for what. The Office of MaineCare Services (OMS) writes policy and runs covered services. The Office for Family Independence (OFI) — a separate office inside DHHS — handles every Medicaid application, eligibility determination, and change report. Both share the DHHS roof; neither office handles each other's work.

Which number you need depends on what you're trying to do

Gainwell Technologies runs the back office

MaineCare contracts with Gainwell Technologies for the MIHMS claims system, the Health PAS Online provider portal, and provider enrollment. Members rarely interact with Gainwell directly — provider-facing lines (1-866-690-5585) and Gainwell email addresses (mainecareprovider@gainwelltechnologies.com, MaineCareEnroll@gainwelltechnologies.com) are for clinicians and billing staff, not for members.

Apply online

The online portal for every DHHS benefit, including MaineCare, is MyMaineConnection.gov. Applications submitted there route to OFI for processing.

Who qualifies for MaineCare?

Maine names its expansion category in plain language. The MaineCare coverage page lists "Adults between age 21 and 64 who are not eligible for Medicare" as a discrete eligibility group — that's the state's everyday phrasing for the ACA Medicaid expansion adopted in 2019 after voter referendum. The full-benefit adult coverage groups are unusually short and explicit on the OMS page.

Full-coverage adult groups MaineCare lists

• Parent or Caretaker Relative — guardian, caretaker, or blood/marriage/adoptive relative of a dependent child living with you, with primary responsibility for the child's care.
• Adults between age 21 and 64 who are not eligible for Medicare — the expansion category in plain phrasing.
• Pregnant People — currently pregnant, or had a pregnancy that ended within the last 60 days.
• Former Foster Care Children up to age 26 — must have been in foster care in the State of Maine and enrolled in Medicaid through the State of Maine at age 18, and not otherwise enrolled in Medicaid. That's a tighter test than the federal default (which looks back across any state).

Adults age 65+, eligible for Medicare, or with disabilities are handled separately on the Older Adults and Adults with Disabilities page, which routes them into the non-MAGI coverage tracks.

Children, pregnant people, and limited benefits

Children and young adults under 21 follow a separate eligibility track with their own income thresholds (see the income-limits section below). MaineCare also publishes a Limited Benefits menu — pharmacy-only and dental-only programs, the Private Health Insurance Premium (PHIP) program, and discount drug programs for members above the full-coverage income line. That layered structure means some Mainers get partial MaineCare even when their household income disqualifies them from full coverage.

MaineCare income standards

MaineCare publishes children's income thresholds in plain dollar examples — and they changed substantially on October 1, 2023. Adult eligibility thresholds are published by the Office for Family Independence under the Health Care Assistance pages. Verify current dollar figures with OFI before relying on a specific number, since federal poverty levels update each January.

Children's MaineCare — October 1, 2023 expansion

The state's published examples for "children and young adults under 21 in families" use household income standards of:

• Family of two — up to $59,000 a year may qualify.
• Family of four — up to $90,000 a year may qualify.

These figures from the OMS Children page are illustrative ranges, not exhaustive limits. OFI applies the formal income standards on a case-by-case basis when an application is filed.

Three children's program variations to know

• Katie Beckett — for children under 19 with serious health conditions whose family income is above the regular MaineCare line. Members pay a low-cost monthly premium for full health coverage.
• Full Cost Purchase Option — if a child under 19 loses MaineCare because family income rose, the family can buy MaineCare coverage for up to 18 months or until the child turns 19, whichever comes first. Ask OFI (1-855-797-4357) about this option by name.
• Newborn coverage — if the mother had full MaineCare coverage at the time of birth, the baby keeps MaineCare coverage through their first birthday even if family income later changes.

FPL standards by category

How to apply for MaineCare

Every MaineCare application — online, paper, or phone — routes to the Office for Family Independence (OFI) for processing. OFI is not the same office that writes MaineCare policy (that's OMS), but it's the only door into Medicaid eligibility in Maine.

Ways to apply

• Online (recommended) — MyMaineConnection.gov is the single portal for MaineCare, SNAP, TANF, and the other DHHS benefits. The portal handles status checks, document uploads, and renewals as well as new applications.
• By phone — call OFI at 1-855-797-4357 (TTY: 711) to start an application, ask about a pending case, or report a change in income or household.
• With a free assister — Consumers for Affordable Healthcare (CAHC) at 1-800-965-7476 (TTY: 1-877-362-9570) helps with application questions at no cost. This is a state-recognized assister organization, not a state agency.
• In person — visit one of the DHHS District Offices to apply face-to-face. Use the dhhs.maine.gov/about/contact/offices locator to find the office nearest you.

What happens after submission

OFI reviews the application and may request verification of income, identity, citizenship or qualifying immigration status, and household composition. Federal Medicaid decision deadlines apply: up to 45 days for non-disability applications and up to 90 days for applications based on disability. Coverage can be retroactive up to three months before the application month when the applicant had qualifying medical bills during that window.

If you need help while waiting

Pharmacy questions during the eligibility wait route to the Pharmacy Help Desk at 1-866-796-2463. Member Services for non-pharmacy questions is 1-800-977-6740. Both lines route TTY users through 711.

What MaineCare covers

MaineCare added comprehensive adult dental coverage on July 1, 2022 and extended postpartum coverage to 12 months on August 1, 2022 — two policy changes worth knowing before relying on outdated guidance. Around the same window (July 1, 2022), MaineCare opened full coverage to pregnant people and to anyone under age 21, regardless of citizenship status, using state funds for non-qualified immigrants. That immigration carve-out is a Maine-specific expansion not all states offer.

Adult dental coverage (since July 1, 2022)

Every adult over age 21 with MaineCare full benefits has access to a broad dental package:

• Diagnostic — oral evaluations and X-rays.
• Preventive — cleanings, fluoride, tobacco and substance use counseling.
• Restorative — fillings and crowns.
• Endodontic — root canals.
• Periodontic — gum surgeries and below-the-gum cleanings.
• Dentures — complete, partial, and immediate dentures plus denture repairs.
• Oral surgery — tooth extractions and removal of tumors and lesions.
• Adjunctive — sedation and night guards.

VitalCare for Kids (EPSDT) for members under 21

Maine brands its EPSDT program as VitalCare for Kids. It covers any medically necessary preventive, dental, developmental, behavioral health, or specialty service for a child or young adult under 21 — including services or equipment that adult MaineCare doesn't usually cover, when they are medically necessary to prevent illness or improve a condition.

Pharmacy benefits

• Preferred Drug List — mainecarepdl.org. "Preferred" drugs generally don't need a prior authorization; "Non-Preferred" drugs do.
• Mail-order pharmacies — MaineCare-approved mail-order pharmacies fill 90-day supplies of most generic and brand-name drugs with no copay.
• Drugs for the Elderly and Disabled — discount program for adults age 62+ or with disabilities whose income is above the regular MaineCare line: up to 80% off, with a $2.00 copayment per fill.
• Maine Rx Plus — discount program for members above the regular MaineCare income line: up to 60% off generics, up to 15% off brand-name drugs.

Examples of MaineCare-covered services

• Doctor visits and specialist care
• Prescription medications
• Behavioral health services
• Gender affirming care services, including hormone therapy and surgery
• X-rays and labs
• Emergency and hospital visits
• Annual physical exams and immunizations, including COVID-19 vaccines
• Pap smears, mammograms, and prostate screenings
• Eye exams

What MaineCare does not cover

• Acupuncture
• Cosmetic surgery
• Experimental procedures or drugs
• Health club memberships (such as the YMCA)
• Massage therapy

Copay-free services

MaineCare members never pay a copay for services at Indian Health Service Centers, family planning, emergency department visits, hospice, oxygen and oxygen equipment, tobacco cessation, or 90-day mail-order prescriptions.

Other state Medicaid pages