I can’t imagine anything much more frustrating than having a special needs child and not being able to access any of the MaineCare supported services. If a parent or guardian works and has insurance, they are not eligible for MaineCare assistance. However, all of the services provided by the many mental health agencies are only available to those whose children receive the MaineCare benefit. Some families have gone for years without help or services because they didn’t know they existed or they didn’t know there is a way for the child to become eligible. There is an answer and many families can qualify for services paid for by MaineCare through the Katie Beckett Option.
The Katie Beckett Option is a MaineCare option for children with serious health conditions. It is one of the many ways a child can get MaineCare. It is a process, but well worth the outcome.
To get coverage through the MaineCare Katie Beckett option:
- You must fill out a MaineCare application;
- Your child must be 18 or younger; and
- Your child must meet financial and medical rules.
There are two steps to meet the financial rules:
- First, DHHS will decide if your child can get MaineCare benefits based on your family’s income and assets. If yes, your child will get MaineCare full benefits
- If your child cannot get MaineCare based on your family’s income and assets, DHHS will then see if your child:
- Has his or her own monthly income of under $1656 and assets of $2000 or less; and
- Meets the two medical rules for the MaineCare Katie Beckett option.
These are the two medical rules:
- Your child must meet the Social Security rules for disability. This means your child must have a physical or mental disability that will last at least twelve months. This disability must be serious enough that your child is not able to do what other children of the same age can do. To make sure your child meets this rule, DHHS will ask you for information about your child. They will need your permission to see your child’s medical records.
- Your child is:
- Not living in a hospital or nursing home, psychiatric hospital, or nursing home for children with intellectual disabilities, but needs the level of care they give;
- Or, living in one of these places, is being discharged and continues to need the level of care they give.
How do I apply?
- Fill out a MaineCare application. Be sure to note that your child is disabled.
- Return in person or by mail to DHHS office closest to your home.
- While your application is going through the first phase, gather all documents you have regarding your child’s services and disability. Therapists, special classes at school, IEPs, copies of any treatment notes your child has had. When you receive your letter of denial, add this ‘packet’ when you are resubmitting and ‘applying to Katie Beckett’.
- DHHS will most likely deny your request based on your income, at this point you would re-submit saying ‘I’m applying for Katie Beckett’ and then they will proceed to access your application based on your child’s disability.
After you apply…
- DHHS will decide if your child meets the financial rule and the two medical rules
- DHHS will send a letter with the decision
- DHHS will review your child’s financial and medical eligibility each year.
Once you have become eligible for the Katie Beckett option you will be considered eligible for Maine Care with a Maine Care number and have access to most services provided by the State. Most of these services provided by the State are available at the private agencies within the State of which Spurwink is one. We bill the State of Maine for our Outpatient Community Services that are free to the recipient.
If you have difficulty navigating this process, please feel free to call (207) 871-1200 and ask to speak to one of our Spurwink LINK Coordinators, they will be happy to help you along the way to gaining access to services for your child.
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Cindy Mellin
Consumer Response Supervisor
Spurwink Services