Unwinding Plan for the End of the Medicaid Continuous Coverage Requirement and Resumption of Normal MaineCare Eligibility Operations

The U.S. Department of Health and Human Services (HHS) declared a federal public health emergency (PHE) due to the Coronavirus Disease 2019 (COVID-19) on January 27, 2020. In response, the Department implemented temporary changes to MaineCare (Maine’s Medicaid program) eligibility and enrollment procedures to ensure access to critical health care benefits during the PHE. As a result of those changes, the vast majority of MaineCare members’ benefits remained open to provide continuous coverage during the PHE.

Starting in April 2023, states resumed routine eligibility and enrollment operations, including disenrolling members who are no longer eligible for coverage. States have 12 months from April 1, 2023 to initiate redeterminations for all enrolled members. As described below, subsequent updates have extended that timeframe for many states, including Maine. This period is referred to as the PHE “unwinding.”

The Department’s primary goal is to maximize continuity of coverage for MaineCare members throughout the unwinding, and to connect disenrolled individuals with financial assistance they may be eligible for through the state-based Health Insurance Marketplace (CoverME.gov).

Renewal Plan

Beginning in May 2023, OFI began redetermining eligibility for an estimated 20,000 households, representing approximately 34,000 members, each month. The entire MaineCare unwinding population as of April 2023 is approximately 416,000 members.

Renewal forms are sent on the 21st of the month prior to the month it is due. For example, if the renewal is due July 31, the renewal form will be sent (and available on My Maine Connection) on June 21.

Some members who have not updated their case records by the end of their eligibility period and are likely to change coverage, such as some members enrolled in CubCare or Medically Needy, will be scheduled for renewal within 3 months of the start of individual ex parte reviews in July 2024.

OFI schedules renewals by household, 12 months after the start of benefits or the application month.

Member Communication Plan

OFI will send members three mailings regarding their renewal:

1. Renewal Reminder Notice In the quarter prior to the scheduled renewal, OFI will send a reminder notice to alert the member of the upcoming renewal requirement and to encourage them to update their contact information (see sample notice in Q&A below). Members who provided a cell phone number or email address will also receive similar reminder messages through text or email.
2. Renewal Form This pre-populated paper renewal form will be mailed in an envelope with a blue block with a postage paid return envelope at least 30 days prior to the renewal due date. If it’s blue, it’s time to renew! Members who signed up for e-notices will get an email or text when it is time for their renewal, and will not receive the envelope with the blue block.
3. Notice of Decision
   • If the member completes their renewal timely and remains eligible, a notice of decision will be issued to explain ongoing coverage.
   • If the member completes their renewal timely and no longer qualifies, a notice of decision will be sent at least 15 days before the date coverage is set to end. If the individual may be eligible for coverage through the Marketplace, their information will be sent to CoverME.gov.
   • If the member does not complete their renewal by the due date, a closure notice will be sent on the first of the month following month the renewal was due. Coverage will end the last day of the month following the month the renewal was due. The member will have 90 days from the date MaineCare coverage ends to complete their renewal and see if coverage can continue. However, as noted below, Maine has paused disenrollments for members who do not return their form until individual level passive enrollment is in place.

The first members to go through the redetermination process were those scheduled for renewal in May 2023.

Updates to Maine’s Unwinding Plan

Since the initiation of the unwinding process in April 2023, there have been several policy updates from the federal Centers for Medicare and Medicaid Services (CMS) that have impacted Maine’s unwinding plan and timeline.

“Passive” or “ex parte” renewal is a federal requirement that directs states to check sources showing earned income data to determine a member’s eligibility. If such data sources confirm eligibility, the state automatically renews Medicaid coverage without requiring manual completion or return of a renewal form. Maine implemented passive renewals in August 2023 at the household level.

In August 2023, CMS issued guidance directing about half of states, including Maine, to halt “procedural disenrollment” until passive or “ex parte” renewal at the individual level is implemented.

This means that, until individual-level passive renewal process is effective, a state cannot disenroll a member who has neither been renewed through the passive process nor returned their subsequent renewal form. Maine has continued to pause disenrollments for nonresponse until individual level passive enrollment is implemented in July 2024.

In the fall of 2023, CMS clarified that states can extend the unwinding period. Maine has shifted the end of the issuance of unwinding redeterminations to October 31, 2024, in order to account for additional renewal processing work after the individual-level passive renewal system is in place in July 2024.

Resumption of Standard Eligibility Operations Effective May 1, 2023

In addition to this process to redetermine the eligibility for all MaineCare members described above, the Department implemented a number of eligibility- and enrollment-related programmatic flexibilities in response to the PHE, which will also be phased out beginning on Nov 1, 2024 as follows.

Eligibility Changes

• Premiums will resume for certain coverage groups. Premium payment will be required for members enrolled in Katie Beckett, Special Benefits Waiver, or MaineCare for Working People with Disabilities after the household has completed their annual renewal. The Department has not sought unpaid premiums during the period of the PHE (starting January 2020). Failure to pay premiums after renewal may result in a loss of coverage.
• Verification of financial factors will be required at application, renewal, or reported change if the Department is unable to verify income through electronic data sources.
• Medically Needy deductibles will start again. Individuals who met a deductible to gain MaineCare coverage on or after March 18, 2020, may have had coverage continue past the deductible period (deductibles are typically six months). OFI will redetermine eligibility for these members to determine new deductible amounts for them.

Maximizing Continuity of Coverage

Along with planning for the resumption of standard eligibility operations as described above, the Department facilitates application transfers to CoverME.gov, Maine's Health Insurance Marketplace, for people no longer eligible for MaineCare.

CoverME.gov is conducting targeted outreach to those consumers, sending a series of “Welcome to CoverME.gov” marketing materials via postal mail. Emails, calls, and texts are incorporated as well, based on availability of contact information.

A CoverME.gov Special Enrollment Period for loss of MaineCare coverage is available from April 15, 2023 through December 31, 2024, to coincide with the updated redetermination timeline.

Communication and Outreach

• DHHS has developed multilingual communications and outreach materials for partners and stakeholders available on our Unwinding Communications Resources page.
• Recordings and materials from the DHHS Partner Briefing Series are available on the right-hand column of this page.

Questions about the end of the Continuous Coverage Requirement

During the PHE, most Mainers were allowed to keep their MaineCare coverage even if they did not renew, did not respond to requests for information, or no longer qualified for coverage because of changes like increased income.

Usually if someone does not update their information to renew their coverage, or if someone reports changes that mean they are no longer eligible to receive MaineCare, they will lose their MaineCare coverage. The more flexible rules, referred to as continuous coverage requirement, meant that most individuals in these situations stayed enrolled with MaineCare.

Information about who will be eligible for MaineCare after the continuous coverage requirement ends is available from the DHHS Office for Family Independence online or by calling 1-855-797-4357.

If you are no longer eligible for MaineCare

Even if you do not qualify for MaineCare, you may be able eligible to receive financial help paying for health insurance when you purchase coverage through the individual marketplace. Learn more at CoverME.gov.

What happens to my MaineCare benefits when continuous coverage rules end?

Starting with May 2023 renewals, OFI began reaching out to MaineCare members to check if they still meet the regular eligibility requirements.

This means your benefits could change.

There are two important steps you need to take:

• Right now: Make sure your contact information is correct. Use My Maine Connection (MyMaineConnection.gov) or call OFI at 1-855-797-4357. See the “How do I update my contact information” section below for detailed instructions.
• If you get a renewal form, fill it out and return it right away. Be on the lookout for the envelope with a blue block which will have the renewal information and instructions. If it's blue it's time to renew! If you signed up for e-notices, you will get an email or text when it is time for your renewal.

• Complete a renewal online at www.mymaineconnection.gov.
• You must also return additional information if we ask for it. If we need more information to know if you are still eligible, we will contact you.
• If you don’t respond or provide the information we request when we request it, your MaineCare coverage will end. If we need more information to know if you are still eligible, we will contact you. Even if you think you will no longer be eligible, it is important to respond so that you don’t immediately lose your MaineCare for not responding. We can also help you find other health insurance through CoverME.gov, Maine's Health Insurance Marketplace. See the "What if my income is too high to get MaineCare" section below for more information about accessing affordable health plans through CoverME.gov.

MaineCare redeterminations and normal eligibility requirements resumed in May 2023. All members must complete a renewal to see if they are still eligible for MaineCare. We will send you a notice in an envelope with blue block when it’s time for you to update your information. If you signed up for e-notices, you will get an email or text when it is time for your renewal.

Make sure your contact information is correct so you can receive your renewal notice. See the “How do I update my contact information” section below for instructions.

What should I do to prepare?

Make sure your contact information is correct. The Office for Family Independence (OFI) must have your current contact information, including address, mobile phone, and email to ensure you get important notices, texts, and emails.

If you moved or changed your contact information and have not updated it with OFI, please contact us to provide your current mailing address, phone number, and email. See the “How do I update my contact information” section below for instructions.

There are three important steps you need to take:

Right now: Use My Maine Connection or call OFI at 1-855-797-4357 to make sure your contact information is correct. See the “How do I update my contact information?” section below for detailed instructions.

• Be sure to pay close attention to your mail, email, and text messages.
• When OFI reaches out to you: Complete a renewal form to show that you meet eligibility guidelines in order to continue getting MaineCare coverage.
• OFI will send you a letter in an envelope with ablue block when it is time for you to renew. If it’s blue, it’s time to renew! If you signed up for e-notices, you will get an email or text when it is time for your renewal. You must:
• Complete and return the renewal form by mail

• Complete a renewal online at www.mymaineconnection.gov.

Continue to complete renewals and respond to requests from OFI. This will help ensure your case information is always up to date.

You must also return additional information if requested. If OFI needs more information to know if you are still eligible, OFI will contact you.

If you don’t respond or provide the information requested, your MaineCare coverage will end. Even if you think you will no longer be eligible, it is important to respond so that you don’t immediately lose your MaineCare coverage. The eligibility limits are also different for adults and children, so even if a parent is no longer eligible for MaineCare, their children may still be eligible, and they should still return their renewal.

OFI can also help you explore other health insurance options through resources like CoverME.gov, Maine’s health insurance marketplace.

How did DHHS prepare for the end of the continuous coverage requirement?

The Department has taken the following actions to prepare for the end of the continuous coverage requirement:

• Continued issuing and processing MaineCare renewals throughout the PHE to keep case information as up to date as possible
• Developed enhanced standard operating procedures to ensure the ability to record telephonic signatures for all renewals and applications
• Launched My Maine Connection, a new online portal to apply for benefits, renew current benefits, report changes, submit verifications, request MaineCare cards, and enroll in electronic noticing
• Contacted members who have had mail returned to the Department as undeliverable
• Developed text messaging and email options to alert members of upcoming renewals
• Developed a communication plan to request updated contact information, including conducting outreach to members who may need to update their information
• Published online resources for MaineCare members and stakeholders, including unwinding plans and Frequently Asked Questions
• Partnered with community-based organizations to provide a point of contact for direct assistance to MaineCare members.
• Established a CoverME.gov Special Enrollment Period that coincides with the redetermination process to allow MaineCare members to easily explore plan options and enroll in affordable Marketplace coverage.

There are two ways to easily update your household’s contact information:

1. Online at My Maine Connection
   • If you have an account, sign in and select the “Report a Change” button from your dashboard.
     • Select “Change Information for Current Members” and “Continue”
       
     • Select “Contact Information” and follow the prompts to update your address, phone number, or email.
       
   • If you don’t have an account, click the “Sign Up” link to create one. To access all My Maine Connection features, the person who submitted the application for the household will need to create the account. Then follow the “Report a Change” steps above.
2. Contact OFI by phone at 1-855-797-4357.
   • Press 1 to select the Interactive Voice Response option to update your contact information without waiting for a customer service representative. You will need the last 4 digits of your social security number (SSN) and date of birth.
   • Alternatively, you can wait to speak to a customer service representative to update to your address, email, and phone number.

You must update your address with the Office for Family Independence (OFI) and other State agencies independent of the Postal Service. The USPS does not forward mail from the State of Maine, even if you submitted a change of address with USPS.

If OFI does not have your current contact information, OFI will not be able to reach you to let you know if further information is needed to evaluate your MaineCare eligibility. If OFI does not hear from you, you will lose your MaineCare coverage.

See the “How do I update my contact information” section above for instructions.

When will I get my renewal form?

Renewals restarted starting with members due in May 2023. You might not hear from OFI right away, as it will take time for us to get in touch with all MaineCare members.

OFI will be reaching out to people based on their renewal date, which is listed in the upper right-hand corner of Notices of Decision sent to you by OFI.

Your renewal form will be sent at least 30 days before your scheduled renewal date. Renewal forms will be sent on the 21st of the month prior to the month it is due. For example, if your renewal is due April 30, 2024, your renewal form will be sent (and available on My Maine Connection) on March 21, 2024. It will come in an envelope with a blue block. If it’s blue it’s time to renew! If you signed up for e-notices, you will get an email or text when it is time for your renewal.

Alternatively, you can create an account at My Maine Connection and use it connect to benefits and to see your current MaineCare eligibility and manage your benefits. To create an account:

1. Click the “Sign Up” link on the My Maine Connection homepage.

2. Enter the required fields to create an account.

• If you are currently receiving benefits make sure to select “Yes” to the question about connecting to benefits. This step is necessary to complete your renewal.
• When it’s time for you to renew, the “Renew Benefits” button will appear on your dashboard. Click the “Renew Benefits” button to review your case information and submit a renewal.

If you do not see a “Renewal” button, it is not time for you to renew yet.

Will I receive reminders about my renewal?

OFI will mail you a reminder notice at least one month before sending you your renewal form. If you signed up for e-notices, you will get an email or text instructing you to go to mymaineconnection.gov to view your renewal notice.

The notice encourages you to update your contact information if it has changed and includes information about when OFI will send your renewal form and when you must complete and submit it.

OFI will send you your renewal form at least 30 days before your scheduled renewal date. OFI will send the renewal form on the 21st of the month prior to the month it is due. For example, if your renewal is due May 31, 2024, OFI will send your renewal form (and it will be available on My Maine Connection) on April 21, 2024. It will come in an envelope with a blue block. If it’s blue, it’s time to renew!

If you provide OFI with a cell phone number or email address, you may also receive texts or emails to remind you when your renewal is due.

What else do I need to know about my renewal?

Your renewal is important. It can help you avoid gaps in healthcare coverage or delays. Please be sure to:

1. Make sure your contact information is correct. See the “How do I update my contact information” section above for detailed instructions.

2. Get your completed renewal to the Office for Family Independence early. Don’t wait until the last day! If we don’t receive your renewal by the due date, your MaineCare coverage will end.

3. Send or submit proof of income or pre-tax deductions with your renewal.

Documents that show proof of income or pre-tax deductions that OFI may request once we receive your renewal includes:

• Last 4 weeks’ pay stubs, if employed
• Most recent tax return or business records, if self-employed
• Pre-tax deductions, such as student loan interest, IRA deductions, or health savings account deductions
• We can accept renewals online 24 hours a day, seven days a week at My Maine Connection.

If you don’t complete your renewal before the due date, your MaineCare coverage will end. The Office for Family Independence will send you a notice at least 15 days before the date coverage is set to end.

I received a notice that my MaineCare stopped because I didn’t complete a renewal. What should I do?

You have 90 days from the date your MaineCare coverage ended to complete your renewal to see if your coverage can continue.

Visit My Maine Connection to complete the renewal as soon as possible to avoid a gap in coverage. You may also call the Office for Family Independence at 1-855-797-4357 to complete your renewal over the phone, or complete the paper renewal and mail it back to:

• Office for Family Independence
• 114 Corn Shop Lane
• Farmington, ME 04938

If it has been over 90 days, you must submit a new application. See how to apply here.

What if my income is too high to get MaineCare? Is there some place I can get affordable health insurance?

If you are not eligible for MaineCare because your income is too high, you may be able to get help paying for health insurance through CoverME.gov, Maine’s Health Insurance Marketplace.

You should complete your renewal even if you think you may no longer qualify for MaineCare. If the Office for Family Independence determines that you may be eligible for coverage through CoverME.gov, Maine’s Health Insurance Marketplace.

CoverME.gov, is offering a Special Enrollment Period (SEP) to help Maine people transitioning from MaineCare coverage after the COVID-19 pandemic explore affordable health insurance options and avoid gaps in coverage. The Special Enrollment Period began on April 15, 2023 and will continue until December 31, 2024. You don’t have to wait for your MaineCare coverage to end to take advantage of this opportunity. If you are found ineligible for MaineCare during your renewal process because of income or other reasons, your information will be transferred automatically to CoverME.gov. When you complete the application, CoverME.gov will determine if you are eligible for financial assistance to lower CoverME.gov premium or out-of-pocket costs.

To take advantage of the Special Enrollment Period visit CoverME.gov and follow these steps:

1. Create or log into your account.

2. Submit or review your application.

3. Select “Recently lost MaineCare” from the list of Special Enrollment Periods.

4. Shop for plans and submit your enrollment. Your plan will start the first of the month after your plan selection.

Who can I call if I need help with a renewal or have questions?

Need extra help?

If you have questions or require additional help, we encourage you to reach out to Consumers for Affordable Health Care (CAHC), a non-profit committed to helping all Maine people obtain quality, affordable health care: Consumers for Affordable Health Care Assistance Helpline: 1-800-965-7476.

DHHS is also partnering with local community-based organizations (CBOs) across the state to help Maine people with the unwinding process. These organizations provide culturally relevant outreach and education to minimize unnecessary coverage loss and facilitate transitions to the marketplace during the end of the Medicaid Continuous Coverage Requirement

These CBO partners can:

• Explain the unwinding process and answer questions,
• Help you complete your MaineCare reenrollment, and
• Assist those no longer eligible for MaineCare to find options for affordable health care coverage through CoverME.gov, Maine’s Health Insurance Marketplace.

Unwinding CBO Partners:

• Ak Health and Social Services
• Gateway Community Services Maine
• Healthy Acadia
• Maine Access Immigrant Network
• Maine Immigrants and Refugee Services (MEIRS)
• Maine Immigrant Rights Coalition
• Maine Association For New Americans
• Mano en Mano / Hand in Hand
• New England Arab American Organization
• Greater Portland Health
• Preble Street
• Presente! Maine
• Sustainable Livelihoods Relief Organization
• United Somali Women of Maine
• Wabanaki Public Health and Wellness