You may have gotten a letter from the Department of Health and Human Services about changes in what are called MaineCare Section 17 - Community Support Services. Here is some information about possible changes to your case management, daily living supports and other services.
Does This Mean I Am Losing MaineCare?
No. You are not losing your MaineCare. It means that you may no longer get this one service from your current provider.
Can I Still Get Mental Health Services to Help With My Issues?
Yes. You are still eligible to get services to help with your mental health issues. There may be a change in how you get those services, but you are still eligible for help.
How Can I Make Sure That I Still Get Services That I Need?
Step 1: Ask your current mental health provider if you are at risk with losing your current MaineCare Section 17 services.
Step 2: Make sure that your mental health provider sends DHHS a “Prior Authorization” request on time. If they miss the deadline, you may lose your services.
Step 3: If DHHS denies your Prior Authorization, you must appeal within ten (10) days to keep your Section 17 services.
Step 4: If your mental health provider tells you that you can no longer get Section 17 services, ask them to help you find a new provider to give you the services you need. A new provider will be under what are called either Section 92 - Behavioral Health Homes or Section 65- Behavioral Health Services. You can keep your Section 17 services for 120-days, or longer, so that you can get set up with a new provider.
Step 5: Call MaineCare Member Services at 1-800-977-6740. Make sure you ask them to give you a list of Section 92 or Section 65 providers in your area. Call those providers.
Important: For each provider that you call, please keep track of:
The date that you called;
Who you spoke with (the name of the agency and the name of the person); and
What they told you about why they cannot help you.
What Can I Do If I Cannot Find The Services That I Need?
If you still cannot get help, after trying everything above, then call:
Disability Rights of Maine at 1-800-452-1948 , or
Maine Equal Justice Partners at 626-7058, ext. 202
I have a Prior Authorization to receive Section 17 until sometime after April 8th. Can I continue to access services until my Prior Authorization expires?
Yes. If you have a Prior Authorization for Section 17, your services will not end on April 8th. You can continue to get services through the end of the authorization period. Once your Prior Authorization ends, you and your provider will need to request a new one.
If my provider requests a new Prior Authorization and it is denied, but I appeal it in a timely manner, will I continue to receive services until the appeal is resolved?
Yes. If your Prior Authorization is denied, you will receive a letter. This letter will let you know that you have the right to appeal, and it will give you a deadline for filing this appeal. If you file your appeal before the deadline, you will continue to receive services until a final decision has been made.
If I have a diagnosis of: Neurocognitive Disorders, Neurodevelopmental Disorders, Antisocial Personality Disorder or Substance Use Disorders AND I have another diagnosis that is still covered under Section 17, can I continue to receive services under Section 17 for all of these conditions?
Yes, if you otherwise meet the Section 17 eligibility criteria, you can receive services even if you have diagnoses of Neurocognitive Disorders, Neurodevelopmental Disorders, Antisocial Personality Disorder or Substance Use Disorders. You should work with your provider on compiling the information you may need.