MaineCare Disability Eligibility: Income Limits, Deductible, and Waivers

MaineCare disability eligibility rests on two things: meeting the Social Security Administration’s definition of disability, and fitting your income and assets into one of several coverage tracks the state offers. If you already receive SSI or SSDI, the disability piece is settled. If you don’t, Maine will make its own determination using the same federal standard.¹²

The financial side is where most questions arise, because Maine uses several different income and asset limits depending on your age, whether you work, and whether a child or an adult is applying. The sections below walk through each door into coverage.

How Maine Decides You’re Disabled

MaineCare uses the SSA’s disability definition. People already receiving SSI are enrolled automatically, provided they don’t refuse to assign their rights to medical payments.¹ People receiving SSDI are treated as meeting the disability condition without a separate finding.²

If you don’t have either benefit, you can ask Maine to decide. The MaineCare Disability Determination form, available through the DHHS Office for Family Independence, applies the SSA standard directly through the state.²³ Submit it alongside your MaineCare application.

Income and Asset Limits by Track

Disability categories are evaluated under non-MAGI rules, which means both income and assets are counted, with some disregards.⁴ Which numbers apply to you depends on which track you fit.

Standard Disabled (With Medicare or Age 65+)

For a disabled adult who has Medicare, or anyone 65 and older, the 2026 monthly income limits are $1,330 for an individual and $1,804 for a couple. Assets are capped at $2,000 for an individual and $3,000 for a couple.⁵ SSDI counts as income in this calculation.²

Working Disabled

If you have a disability and earn income from a job or self-employment, the ceiling is much higher. MaineCare for Working People with Disabilities uses 250% of the Federal Poverty Level, which for 2026 is $3,325 per month for an individual and $4,509 for a couple. Asset limits also rise, to $8,000 for an individual and $12,000 for a couple.⁵ You must be under 65 and meet the SSA disability standard.⁶

The program is free for some enrollees. Those with higher incomes pay a premium of $10 to $20 per month, unless they already pay a Medicare Part B premium.⁶

If Your Income Is Too High: The Deductible

Over the limit? Maine’s medically needy “spend-down,” called a deductible, can still bring you under coverage. You accumulate medical bills up to a threshold, and once that threshold is met, MaineCare pays for the rest of a set period.

The threshold is calculated by subtracting a Protected Income Level from your monthly countable income, then multiplying by six months. Protected Income Levels are $315 for one person, $341 for two, $458 for three, and $575 for four. So a single person with $1,100 a month in income would face a six-month deductible of $4,710.⁷

A few practical points matter. The bills do not have to be paid; they only have to total the threshold. Old unpaid bills count. Hospital charity care counts too, but apply for it only after the deductible is met. Anything another insurer like Medicare already covered does not count. If you expect one large expense, you can also request a one-month retroactive deductible, which uses a smaller threshold but gives a shorter coverage window.⁷

Coverage for a Child With a Disability: Katie Beckett

If you’re a parent and your household income is too high for standard MaineCare, the Katie Beckett option can still cover a disabled child under 19 who lives at home. The program is for children who need the level of care typically provided in a nursing facility, psychiatric hospital, or group home.⁸

What makes this track different: only the child’s own income and assets count toward eligibility, not the parents’. The child’s assets must be under $2,000. Parental income is used only to set a monthly premium and to confirm the child doesn’t fit another MaineCare group first; children must be found ineligible for other categories before Katie Beckett is considered.² Approved children receive full MaineCare benefits.⁹

Home and Community-Based Services Waivers

Standard MaineCare covers medical care. If you also need help at home or in the community so you can avoid an institutional placement, that comes through one of five Medicaid 1915(c) waivers.¹⁰ Each is targeted to a different population:

Section 19 serves adults 18 and older with physical disabilities and people 65 and older who meet a hospital or nursing facility level of care. Services include personal and attendant care, respite, assistive technology, home-delivered meals, environmental modifications, non-medical transportation, personal emergency response systems, and skills training.¹¹
Section 18 is for adults 18 and older with an acquired brain injury from trauma, infection, anoxia, or vascular lesions. Birth injuries and degenerative or congenital conditions are not covered. A qualified neuropsychologist or board-certified physician must document moderate to severe behavioral, cognitive, or functional disability and rehabilitation potential.¹²
Section 20 covers adults 21 and older with a “related condition” under 42 C.F.R. § 435.1010, which typically includes conditions such as cerebral palsy and epilepsy.¹³
Sections 21 and 29 both serve people 18 and older with intellectual disabilities or autism spectrum disorder. Section 21 is the Comprehensive Waiver; Section 29 is the Support Waiver. You can be enrolled in only one at a time.¹⁴

You must be found eligible for MaineCare, financially and medically, before any waiver can authorize services. And a medical finding alone does not guarantee funded services; actual delivery depends on provider availability and program capacity.¹²

How to Apply

Apply online at My Maine Connection (mymaineconnection.gov), where you can also track your case and report changes.¹⁵ You can also apply by phone at 1-855-797-4357, by mail or fax to the Office for Family Independence, by email to Farmington.DHHS@maine.gov, or in person at a local OFI office.¹⁶

If you don’t already receive SSI or SSDI, submit the MaineCare Disability Determination form with your application. If you’re seeking long-term care or waiver services, you also need to file a separate Long Term Care Application.³ A DHHS caseworker will follow up and may ask for more documentation.¹⁵

You can name an authorized representative to apply, report changes, or receive notices for you.¹⁶ Free help is available from Consumers for Affordable Health Care at 1-800-965-7476.¹⁷

What’s Changing in 2026 and 2027

Federal budget reconciliation legislation enacted in July 2025 reshapes several parts of MaineCare. Starting December 31, 2026, Medicaid expansion adults must document at least 80 hours a month of work, volunteering, or education to keep coverage. Maine estimates more than 31,000 people could lose coverage in the first year due to documentation barriers.¹⁸

People with disabilities are exempt from the work requirement. So are people classified as “medically frail,” which includes those with serious or complex medical conditions, mental health disorders, or substance use disorders. States must check available data to verify exemption status before asking individuals to document it, although federal guidance on defining and verifying these exemptions is still pending.¹⁹

Separately, eligibility redeterminations shift from annual to semiannual starting January 1, 2027, and retroactive coverage for newly approved members is reduced.¹⁸

A Note on Estate Recovery

If you enroll in MaineCare at age 55 or older, Maine may seek repayment from your estate after death, limited to what MaineCare paid for nursing facility services, home and community-based services, and related hospital and prescription drug services.²⁰²¹²²

1
Cornell Law Institute. 10-144 C.M.R. Ch. 332 § 6-1
2
CoverME.gov. MaineCare Eligibility Guidelines
3
Maine DHHS. Applications and Forms
4
Cornell Law Institute. 10-144 C.M.R. Ch. 332 § 3.5-2
5
Consumers for Affordable Health Care. 2026 MaineCare Eligibility Guidelines
6
Consumers for Affordable Health Care. Who Can Get MaineCare Coverage
7
Pine Tree Legal Assistance. MaineCare Deductible – How Does It Work
8
Maine DHHS. Katie Beckett Option
9
Acentra Health. Katie Beckett Benefit
10
Maine DHHS. HCBS Initiatives
11
Medicaid.gov. ME Elderly and Adults With Disabilities Waiver
12
Maine DHHS. Adults With Brain Injury
13
Cornell Law Institute. 10-144 C.M.R. Ch. 332 § 13-1
14
Maine DHHS. Waiver Services for Adults With Intellectual Disability and Autism
15
Pine Tree Legal Assistance. My Maine Connection Online Benefits Application Tool
16
My Maine Connection. MaineCare Program Page
17
Maine DHHS. Health Care Assistance
18
Maine DHHS. Federal Budget Reconciliation Law Impacts on MaineCare and SNAP
19
Center on Budget and Policy Priorities. States Need More Time to Prepare for Medicaid Work Requirement
20
GovDelivery (Maine HHS). MaineCare Estate Recovery Rule Adoption
21
Maine State Legislature. Title 22 § 14
22
WGME. MaineCare Collects Millions Through Estate Recovery