Maine Medicaid pays for in-home personal care and related services through 3 programs, including the Home and Community Benefits for the Elderly and Adults with Disabilities (MaineCare Section 19) and the Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder (MaineCare Section 29). The Office of Aging and Disability Services (OADS) runs these MaineCare programs on a fee-for-service basis. Section 19 has a program cap of $6,565.00 per member per month (effective April 1, 2020) and allows a spouse to be paid as a personal support specialist when the member needs extraordinary care. Sections 21 and 29 list the same sample services.
Yes. OADS lists MaineCare Consumer Directed Attendant Services and MaineCare Private Duty Nursing Services, plus state-funded home care and Independent Support Services (homemaker), alongside the Section 19 waiver.
Which Maine waivers can a home care agency bill?
Each waiver below lists who it covers, the services it pays for, and how providers bill.
Home and Community Benefits for the Elderly and Adults with Disabilities (MaineCare Section 19)
Population
Older adults and adults with physical disabilities who meet nursing facility level of care on the Medical Eligibility Determination assessment.
Services covered
personal care services (personal support services)
attendant services (participant-directed)
respite services
home health services
care coordination
home delivered meals
personal emergency response system
transportation
assistive technology
financial management services
Billing format
Services must be in an Authorized Plan of Care from the Assessing Services Agency; providers of personal care, attendant, and in-home respite must use EVV, either the free Maine DHHS system or their own compliant system.
To bill Medicaid for home care you need a state license, a Type 2 NPI, state Medicaid enrollment and screening, waiver or managed care contracts, EVV and authorizations.
Private pay means higher rates and fast payment; Medicaid means steady volume at state-set rates with authorizations and EVV. Compare rates, cash timing and admin before you mix them.
Track units remaining, the end date and the service code for every client, and check them before each schedule change. Hours over the cap are unbillable.
Four units equal one hour. How to convert units to hours, the common HCPCS codes, how states round partial units, and how to stay inside the authorization.
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