1.Program established.
The Children's Health Insurance Program is established to provide health coverage for low-income children who are ineligible for benefits under the Medicaid program and who meet the requirements of subsection 2. The purpose of the Children's Health Insurance Program is to provide health coverage to as many children as possible within the fiscal constraints of the program budget and without forfeiting any federal funding that is available to the State for the State Children's Health Insurance Program through the federal Balanced Budget Act of 1997, Public Law 105-33, 111 Stat. 251, referred to in this section as the Balanced Budget Act of 1997.
2.Eligibility; enrollment.
Health coverage under the Children's Health Insurance Program is available to children under 19
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1.
Program established.
The Children's Health Insurance Program is established to provide health coverage for low-income children who are ineligible for benefits under the Medicaid program and who meet the requirements of subsection 2. The purpose of the Children's Health Insurance Program is to provide health coverage to as many children as possible within the fiscal constraints of the program budget and without forfeiting any federal funding that is available to the State for the State Children's Health Insurance Program through the federal Balanced Budget Act of 1997, Public Law 105-33, 111 Stat. 251, referred to in this section as the Balanced Budget Act of 1997.
2.
Eligibility; enrollment.
Health coverage under the Children's Health Insurance Program is available to children under 19 years of age who meet the requirements set forth in paragraph C.
2-A.
Persons 19 and 20 years of age.
3.
Program administration; benefit design.
With the exception of any requirements imposed under this section, the Children's Health Insurance Program must be integrated with the Medicaid program and administered with it in one administrative structure within the department, with the same enrollment and eligibility processes, benefit package and outreach and in compliance with the same laws and policies as the Medicaid program, except when those laws and policies are inconsistent with this section and the Balanced Budget Act of 1997. The department shall adopt and promote a simplified eligibility form and eligibility process.
4.
Benefit delivery.
The Children's Health Insurance Program must use, but is not limited to, the same benefit delivery system as the Medicaid program, providing benefits through the same health plans, contracting process and providers. Copayments and deductibles may not be charged for benefits provided under the program.
5.
(TEXT EFFECTIVE UNTIL CONTINGENCY: See PL 2021, c. 635, Pt. CCC, §7) Premium payments.
Premiums must be paid in accordance with this subsection.
5.
(TEXT REPEALED ON CONTINGENCY: See PL 2021, c. 635, Pt. CCC, §7) Premium payments.
6.
Incentives.
In the contracting process for the Children's Health Insurance Program and the Medicaid program, the department shall create incentives to reward health plans that contract with school-based clinics, community health centers and other community-based programs.
7.
Administrative costs.
The department shall budget 2% of the costs of the Children's Health Insurance Program for outreach activities. After the first 6 months of the program and to the extent that the program budget allows, the department may expend up to 3% of the program budget on activities to increase access to health care. In addition, the department shall apply for additional federal funds available for Medicaid outreach activities. The goal of outreach activities under this subsection is to enroll 100% of children eligible for the Children's Health Insurance Program or the MaineCare program.
8.
Quarterly determination of fiscal status; reports.
On a quarterly basis, the commissioner shall determine the fiscal status of the Children's Health Insurance Program, determine whether an adjustment in maximum eligibility level is required under subsection 2, paragraph B and report to the joint standing committee of the Legislature having jurisdiction over appropriations and financial affairs and the joint standing committee of the Legislature having jurisdiction over health and human services matters on the following matters:
9.
Provisions applicable to federally recognized Indian tribes.
After consultation with federally recognized Indian nations, tribes or bands of Indians in the State, the commissioner shall adopt rules regarding eligibility and participation of children who are members of a nation, tribe or band, consistent with Title 30, section 6211, in order to best achieve the goal of providing access to health care for all qualifying children within program requirements, while using all available federal funds.
10.
Rulemaking.
The department shall adopt rules in accordance with Title 5, chapter 375 as required to implement this section. Rules adopted pursuant to this subsection are routine technical rules as defined by Title 5, chapter 375, subchapter 2‑A.
11.
Children's Health Insurance Program drug rebate agreement.
Effective October 1, 1999, the department shall enter into a drug rebate agreement with each manufacturer of prescription drugs that results in a rebate equal to that which would be achieved under the federal Social Security Act, Section 1927.
12.
(TEXT EFFECTIVE UNTIL CONTINGENCY: See PL 2021, c. 635, Pt. CCC, §7) Premium rate review; adjustment.
Effective July 1, 2004, the department shall periodically evaluate the amount of premiums charged under this section to ensure that the premiums charged reflect the most current benefit cost per child. The commissioner shall adjust the premiums by rule. Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter 2‑A.
12.
(TEXT REPEALED ON CONTINGENCY: See PL 2021, c. 635, Pt. CCC, §7) Premium rate review; adjustment.
RR 1997, c. 2, §46 (RAL). PL 1999, c. 401, §§QQ1,2 (AMD). PL 1999, c. 401, §QQ5 (AFF). PL 1999, c. 522, §1 (AMD). PL 1999, c. 731, §§PP1,2 (AMD). PL 1999, c. 790, §A61 (AFF). PL 2001, c. 450, §A3 (AMD). PL 2003, c. 20, §K10 (AFF). PL 2003, c. 673, §§TTT1,2 (AMD). PL 2003, c. 673, §§TTT3,5 (AFF). PL 2005, c. 683, §A34 (AMD). PL 2017, c. 284, Pt. SSSSSS, §1 (AMD). PL 2021, c. 635, Pt. CCC, §3 (AMD). PL 2021, c. 635, Pt. CCC, §7 (AFF). PL 2023, c. 405, Pt. A, §62 (AMD). PL 2023, c. 597, §11 (AMD).